1043355761 NPI number — QUALITY CARE DEVELOPMENTAL SERVICES INC.

Table of content: (NPI 1043355761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043355761 NPI number — QUALITY CARE DEVELOPMENTAL SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY CARE DEVELOPMENTAL SERVICES 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:
Provider Other Organization Name Type Code:
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:
1043355761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28145-2748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-645-2397
Provider Business Mailing Address Fax Number:
704-633-5461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HARREL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-5868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-645-2397
Provider Business Practice Location Address Fax Number:
704-633-5461
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
TARA
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
EXE. DIRECTOR
Authorized Official Telephone Number:
704-798-2851

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL080-136 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6603485 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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