Provider Demographics
NPI:1225645310
Name:QUANTUM GRACE SOLUTIONS LLC
Entity Type:Organization
Organization Name:QUANTUM GRACE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOYEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-779-2070
Mailing Address - Street 1:6555 SUGARLOAF PKWY STE 307-106
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4930
Mailing Address - Country:US
Mailing Address - Phone:678-779-2070
Mailing Address - Fax:
Practice Address - Street 1:6555 SUGARLOAF PKWY STE 307-106
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4930
Practice Address - Country:US
Practice Address - Phone:678-779-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health