Provider Demographics
NPI:1033310636
Name:QBC HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:QBC HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANCI
Authorized Official - Middle Name:SHERMAINE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:337-623-2353
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71353-0617
Mailing Address - Country:US
Mailing Address - Phone:337-623-2353
Mailing Address - Fax:337-623-2369
Practice Address - Street 1:509 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:LA
Practice Address - Zip Code:71353
Practice Address - Country:US
Practice Address - Phone:337-623-2353
Practice Address - Fax:337-623-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1778575251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1778575Medicaid