Contract Details
Ancillary Care Services
Facility name
Home Care Delivered
Provider ID
P000004098
NPI
1245239540
Tax ID
541818883
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
4144 Innslalke Drive
Glen Allen, VA 23060
United States
County
Henrico
Phone
8005656167 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address