MEDICARE: VAN DYCK HOME CARE ENTERPRISES, 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	251E00000X	Home Health Agency	015436	TX

General Provider Information

NPI Number	:	1952666539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN DYCK HOME CARE ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	4647 YUCCA FLATS TRL
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76108-8333
Country	:	US
Telephone Number	:	361-815-4446
Fax Number	:	817-249-6802

Provider Business Practice Location Address
First Line	:	9608 BARTLETT CIR STE 150
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4449
Country	:	US
Telephone Number	:	817-249-6800
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	ELIZABETH A VAN DYCK
Credential	:	RN
Telephone Number	:	817-249-6800

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	12/19/2023

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