MEDICARE: DEDICATED CARE HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251E00000X	Home Health Agency
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1316397565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEDICATED CARE HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	5571 SAINT CHARLES DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3537
Country	:	US
Telephone Number	:	301-257-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	5571 SAINT CHARLES DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3537
Country	:	US
Telephone Number	:	301-257-3504
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. THOMAS AMIBANG TANUE
Credential	:
Telephone Number	:	301-257-3504

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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