Provider Demographics
NPI:1235431453
Name:AVID QUALITY CARE
Entity Type:Organization
Organization Name:AVID QUALITY CARE
Other - Org Name:SHELLY CLARK DBA AVID QUALITY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-205-7070
Mailing Address - Street 1:214 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-4803
Mailing Address - Country:US
Mailing Address - Phone:214-205-7070
Mailing Address - Fax:877-747-2843
Practice Address - Street 1:214 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-4803
Practice Address - Country:US
Practice Address - Phone:214-205-7070
Practice Address - Fax:877-747-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management