Provider Demographics
NPI:1568872851
Name:FIDELIA HOSPICE, INC.
Entity type:Organization
Organization Name:FIDELIA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:562-403-0306
Mailing Address - Street 1:4210 EAGLE ROCK BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4543
Mailing Address - Country:US
Mailing Address - Phone:562-403-0306
Mailing Address - Fax:562-332-6175
Practice Address - Street 1:4210 EAGLE ROCK BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4543
Practice Address - Country:US
Practice Address - Phone:562-403-0306
Practice Address - Fax:562-332-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based