Healthcare Provider Details

I. General information

NPI: 1982142378
Provider Name (Legal Business Name): DEDICATED CARE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 SAINT CHARLES DR
WOODBRIDGE VA
22193-3537
US

IV. Provider business mailing address

5680 KING CENTRE DR SUITE 600
ALEXANDRIA VA
22315-5757
US

V. Phone/Fax

Practice location:
  • Phone: 703-745-7785
  • Fax: 571-659-2453
Mailing address:
  • Phone: 703-745-7785
  • Fax: 571-659-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-171568
License Number StateVA

VIII. Authorized Official

Name: MR. THOMAS AMIBANG TANUE
Title or Position: CEO
Credential:
Phone: 301-257-3504