NPIMap

Organization Active NPI

Fidelity Home Health LLC

  • Home Health Agency
  • Feasterville Trevose, PA
National Provider Identifier
1144569849
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
04880501 Issued in PA
Legal business name
FIDELITY HOME HEALTH LLC
Practice address
139 Bustleton Pike
Feasterville Trevose, PA 19053-6467
Phone
(215) 710-0515
Fax
(215) 710-0258
NPI assigned
Jan 31, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Yelena Kuznetsov, RNNPI 1740806900
Title
Director of Nursing
Phone
(215) 710-0515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 04880501 PA Primary

Addresses

Primary practice location

139 Bustleton Pike
Feasterville Trevose, PA 19053-6467

Mailing address

83 Bustleton Pike Unit C
Feasterville Trevose, PA 19053-6465
Phone (215) 710-0515

Other identifiers 1

IdentifierTypeStateIssuer
102852380MedicaidPA

Other names 1

  • Home Care Agency Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130315000382 PA Part A Provider - Home Health Agency 9537304720 Practice locations: Feasterville Trevose, PA

Home health agency certification: CCN 398201

Legal name
FIDELITY HOME HEALTH LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 19, 2013
Last certification
Jun 19, 2013
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Apr 29, 2012 in PA
Enrollment address
83 Bustleton Pike
Unit C
Feasterville Trevose, PA 19053-6465

Care Compare: Home health agency

Medicare Care Compare
Listed as
Fidelity Home Health LLCCCN 398201
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jun 19, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2058419Fidelity Home Health LLC83 Bustleton Pike, Unit C, Feasterville, PA 19053Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory

Locations

83 Bustleton Pike
Unit C
Feasterville Trevose, PA 19053
Phone (215) 710-0515

139 Bustleton Pike
Fstrvl Trvose, PA 19053
Phone (215) 710-0515

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Yelena Kuznetsov Individual 5% Or Greater Direct Ownership InterestAdmin/Director of Nursing Jan 1, 2013 100%
Corporate DirectorBoard Member Jan 1, 2013
W-2 Managing EmployeeBoard Member Jan 1, 2013

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1144569849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 BUSTLETON PIKE UNIT C",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190536465",
            "telephone_number": "215-710-0515",
            "fax_number": "215-710-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 BUSTLETON PIKE",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190536467",
            "telephone_number": "215-710-0515",
            "fax_number": "215-710-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIDELITY HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-31",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "KUZNETSOV",
        "authorized_official_first_name": "YELENA",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "215-710-0515",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "04880501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102852380",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Home Care Agency",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Home Care Agency",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Feasterville Trevose, PA

Sources for this page

Verify at the official NPI Registry.