Provider Demographics
NPI:1558622621
Name:DEDICATED CARE
Entity Type:Organization
Organization Name:DEDICATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRU
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:NDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-595-6514
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUIT 504R
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3269
Mailing Address - Country:US
Mailing Address - Phone:240-595-6514
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUIT 504R
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3269
Practice Address - Country:US
Practice Address - Phone:240-595-6514
Practice Address - Fax:240-595-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health