Provider Demographics
NPI:1407334816
Name:DEDICATED CARE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:DEDICATED CARE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:AMIBANG
Authorized Official - Last Name:TANUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-723-1200
Mailing Address - Street 1:7600 GEORGIA AVE NW STE 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1616
Mailing Address - Country:US
Mailing Address - Phone:202-723-1200
Mailing Address - Fax:202-723-1211
Practice Address - Street 1:7600 GEORGIA AVE NW STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1616
Practice Address - Country:US
Practice Address - Phone:202-723-1200
Practice Address - Fax:202-723-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC060117-312251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC060117-312OtherDBH - CORE SERVICE AGENCY CERTIFICATION