MEDICARE: BREW HOME CARE AGENCY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770714933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREW HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	4207 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-763-0563
Fax Number	:	703-291-1754

Provider Business Practice Location Address
First Line	:	4207 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-763-0563
Fax Number	:	703-291-1754

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ELLEN D DAVIS
Credential	:	RN,MSN
Telephone Number	:	703-763-0563

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	08/05/2009

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Directions to “BREW HOME CARE AGENCY ” Practice Location

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