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	License Number	License Number State
1	251E00000X	Home Health Agency	HCO-171568	VA

General Provider Information

NPI Number	:	1982142378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEDICATED CARE HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	5680 KING CENTRE DR
Second Line	:	SUITE 600
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-5757
Country	:	US
Telephone Number	:	703-745-7785
Fax Number	:	571-659-2453

Provider Business Practice Location Address
First Line	:	5571 SAINT CHARLES DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3537
Country	:	US
Telephone Number	:	703-745-7785
Fax Number	:	571-659-2453

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

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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