Provider Demographics
NPI:1033685771
Name:QUALITY CARE COORDINATION LLC
Entity Type:Organization
Organization Name:QUALITY CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-838-4776
Mailing Address - Street 1:1625 HOFFNAGLE ST APT B3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2248
Mailing Address - Country:US
Mailing Address - Phone:267-838-4776
Mailing Address - Fax:215-893-4386
Practice Address - Street 1:1625 HOFFNAGLE ST APT B3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2248
Practice Address - Country:US
Practice Address - Phone:267-838-4776
Practice Address - Fax:215-893-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103515007Medicaid