Provider Demographics
NPI:1164963674
Name:QUALITY HOME CARE PROFFESIONALS
Entity Type:Organization
Organization Name:QUALITY HOME CARE PROFFESIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-231-1817
Mailing Address - Street 1:6001 SILVER STAR RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-8219
Mailing Address - Country:US
Mailing Address - Phone:267-231-1817
Mailing Address - Fax:407-255-8684
Practice Address - Street 1:6001 SILVER STAR RD STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-8219
Practice Address - Country:US
Practice Address - Phone:888-897-7427
Practice Address - Fax:407-255-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4239428-01Medicaid
FL022760500Medicaid