Provider Demographics
NPI:1548666175
Name:THE FIDELIS GROUP INC
Entity type:Organization
Organization Name:THE FIDELIS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:HM 60525018
Authorized Official - Phone:360-481-8147
Mailing Address - Street 1:921 LAKERIDGE WAY SW STE 203
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6081
Mailing Address - Country:US
Mailing Address - Phone:360-489-1621
Mailing Address - Fax:360-339-4476
Practice Address - Street 1:921 LAKERIDGE WAY SW STE 203
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6081
Practice Address - Country:US
Practice Address - Phone:360-489-1621
Practice Address - Fax:360-339-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-431-168253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care