MEDICARE: DEDICATED HEALTHCARE LLC

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1851989339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEDICATED HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3952 CLAIREMONT MESA BLVD # D438
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2739
Country	:	US
Telephone Number	:	253-539-9886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3952 CLAIREMONT MESA BLVD # D438
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2739
Country	:	US
Telephone Number	:	253-539-9886
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	CHELSEA STONE
Credential	:	MED, BCBA
Telephone Number	:	253-539-9886

Provider Enumeration Date	:	01/09/2021
Last Update Date	:	01/10/2021

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