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General NPI Number Information
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NPI Number | 1316397565
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Entity Type | Organization
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Legal Business Name | DEDICATED CARE HEALTH SERVICES INC
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 5571 SAINT CHARLES DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3537
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Country | US
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Telephone | 301-257-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 5571 SAINT CHARLES DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3537
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Country | US
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Telephone | 301-257-3504
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. THOMAS AMIBANG TANUE
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Credential |
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Telephone | 301-257-3504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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