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General NPI Number Information
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NPI Number | 1417125691
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL CARE HOME HEALTHCARE
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 4227 DIXHILL ROAD SUITE 412
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City | FAIRFAX
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State | VA
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Zip | 22033
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Country | US
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Telephone | 703-218-3630
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Fax | 703-218-3632
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Provider Business Mailing Address
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Address Line | PO BOX 354
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City | FAIRFAX
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State | VA
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Zip | 22038-0354
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Country | US
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Telephone | 703-218-3630
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Fax | 703-218-3632
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Authorized Official
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Title or Position | MANAGEMENT
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Name | MR. DELVIN MACARTHY
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Credential |
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Telephone | 703-218-3630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 212490428
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License Number State | VA
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