Provider Demographics
NPI:1356926331
Name:FIDELITY ENTRUST HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:FIDELITY ENTRUST HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-487-7378
Mailing Address - Street 1:4723 SMOKEY QUARTZ LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-1346
Mailing Address - Country:US
Mailing Address - Phone:817-487-7378
Mailing Address - Fax:817-977-8889
Practice Address - Street 1:4723 SMOKEY QUARTZ LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1346
Practice Address - Country:US
Practice Address - Phone:817-487-7378
Practice Address - Fax:817-977-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty