Healthcare Provider Details

I. General information

NPI: 1043674674
Provider Name (Legal Business Name): MEDCARE HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12567 SUMMIT MANOR DR 313
FAIRFAX VA
22033-5718
US

IV. Provider business mailing address

12567 SUMMIT MANOR DR 313
FAIRFAX VA
22033-5718
US

V. Phone/Fax

Practice location:
  • Phone: 202-270-8256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMARA SHILLINGFORD
Title or Position: C.E.O
Credential:
Phone: 202-270-8256