Provider Demographics
NPI:1417125691
Name:INDIVIDUAL CARE HOME HEALTHCARE
Entity Type:Organization
Organization Name:INDIVIDUAL CARE HOME HEALTHCARE
Other - Org Name:INDIVIDUAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-218-3630
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-0354
Mailing Address - Country:US
Mailing Address - Phone:703-218-3630
Mailing Address - Fax:703-218-3632
Practice Address - Street 1:4227 DIXHILL ROAD
Practice Address - Street 2:SUITE 412
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-218-3630
Practice Address - Fax:703-218-3632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA212490428251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health