MEDICARE: LTC ADULT DAY CARE, INC.

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	261QA0600X	Adult Day Care Clinic/Center		VA

General Provider Information

NPI Number	:	1679950257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LTC ADULT DAY CARE, INC.

Provider Business Mailing Address
First Line	:	8730 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4405
Country	:	US
Telephone Number	:	703-361-5843
Fax Number	:	703-935-3000

Provider Business Practice Location Address
First Line	:	8730 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4405
Country	:	US
Telephone Number	:	703-361-5843
Fax Number	:	703-935-3000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDIRAHIM HUSSEIN
Credential	:
Telephone Number	:	703-361-5843

Provider Enumeration Date	:	05/02/2015
Last Update Date	:	05/02/2015

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