MEDICARE: CENTRE HOME HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center		VA

General Provider Information

NPI Number	:	1306272927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRE HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	12020 SUNRISE VALLEY DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3440
Country	:	US
Telephone Number	:	703-216-5528
Fax Number	:

Provider Business Practice Location Address
First Line	:	12020 SUNRISE VALLEY DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3440
Country	:	US
Telephone Number	:	703-216-5528
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IFRAH ABSHIR FATAH
Credential	:
Telephone Number	:	703-216-5528

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	07/21/2022

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Directions to “CENTRE HOME HEALTH CARE ” Practice Location

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