Healthcare Provider Details

I. General information

NPI: 1679950257
Provider Name (Legal Business Name): LTC ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 05/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 SUDLEY RD
MANASSAS VA
20110-4405
US

IV. Provider business mailing address

8730 SUDLEY RD
MANASSAS VA
20110-4405
US

V. Phone/Fax

Practice location:
  • Phone: 703-361-5843
  • Fax: 703-935-3000
Mailing address:
  • Phone: 703-361-5843
  • Fax: 703-935-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: ABDIRAHIM HUSSEIN
Title or Position: PRESIDENT
Credential:
Phone: 703-361-5843