Provider Demographics
NPI:1164722211
Name:HOLIDAY QUALITY CARE SERVICES INC.
Entity Type:Organization
Organization Name:HOLIDAY QUALITY CARE SERVICES INC.
Other - Org Name:JUDY HOLIDAY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:C.EO./WAIVER SUPPORT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HOLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-784-7414
Mailing Address - Street 1:17270 89TH PL N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-1744
Mailing Address - Country:US
Mailing Address - Phone:561-784-7414
Mailing Address - Fax:561-791-3211
Practice Address - Street 1:17270 89TH PL N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-1744
Practice Address - Country:US
Practice Address - Phone:561-784-7414
Practice Address - Fax:561-791-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL676963296251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL751580496Medicaid
FL751580498Medicaid
FL676963268Medicaid
FL751580468Medicaid
FL676963296Medicaid
FL676963298Medicaid