Provider Demographics
NPI:1043355761
Name:QUALITY CARE DEVELOPMENTAL SERVICES INC.
Entity Type:Organization
Organization Name:QUALITY CARE DEVELOPMENTAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXE. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BA SOCIOLOGY
Authorized Official - Phone:704-798-2851
Mailing Address - Street 1:PO BOX 2748
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-2748
Mailing Address - Country:US
Mailing Address - Phone:704-645-2397
Mailing Address - Fax:704-633-5461
Practice Address - Street 1:301 HARREL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5868
Practice Address - Country:US
Practice Address - Phone:704-645-2397
Practice Address - Fax:704-633-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL080-136322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603485Medicaid