1851531974 NPI number — DAMBRIDGE HEALTH CARE, INC

Table of content: (NPI 1851531974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851531974 NPI number — DAMBRIDGE HEALTH CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAMBRIDGE HEALTH CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAMBRIDGE HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851531974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 JEFFERSON DAVIS HWY UNIT 522
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22555-3622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-300-1160
Provider Business Mailing Address Fax Number:
877-904-3069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 JEFFERSON DAVIS HWY UNIT 522
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22555-3622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-848-5449
Provider Business Practice Location Address Fax Number:
877-904-3069
Provider Enumeration Date:
03/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOATENG
Authorized Official First Name:
NANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
877-287-3079

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HCA.0001211 . This is a "CT. DEPT OF CONSUMER PROTECTION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".