Provider Demographics
NPI:1114348836
Name:QUALITY CARE FOR INDEPENDENCE
Entity Type:Organization
Organization Name:QUALITY CARE FOR INDEPENDENCE
Other - Org Name:QCFI
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRAZZLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-365-7939
Mailing Address - Street 1:7933 GREENLAND PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-1056
Mailing Address - Country:US
Mailing Address - Phone:513-821-9757
Mailing Address - Fax:513-821-0232
Practice Address - Street 1:7933 GREENLAND PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1056
Practice Address - Country:US
Practice Address - Phone:513-821-9757
Practice Address - Fax:513-821-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3110207302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2812335Medicaid