MEDICARE: HEALETH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1023811908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALETH CARE LLC

Provider Business Mailing Address
First Line	:	17407 GRANT COTTAGE DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22025-2032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17407 GRANT COTTAGE DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22025-2032
Country	:	US
Telephone Number	:	571-516-4165
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LINDA BOAKYE
Credential	:
Telephone Number	:	571-353-9972

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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