Fidelity Entrust Healthcare Services LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

FIDELITY ENTRUST HEALTHCARE SERVICES LLC

Practice address

4723 Smokey Quartz LN
Arlington, TX 76005-1346

Phone

(817) 487-7378

Fax

(817) 977-8889

NPI assigned

Mar 11, 2021

Organization subpart

No

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

Authorized official

Name

Eboni M Lyles, RN

Title

Owner

Phone

(817) 487-7378

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1356926331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4723 SMOKEY QUARTZ LN",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760051346",
            "telephone_number": "817-487-7378",
            "fax_number": "817-977-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4723 SMOKEY QUARTZ LN",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760051346",
            "telephone_number": "817-487-7378",
            "fax_number": "817-977-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIDELITY ENTRUST HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-11",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "LYLES",
        "authorized_official_first_name": "EBONI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-487-7378",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Arlington, TX
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• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.