Provider Demographics
NPI:1255838421
Name:CHILDREN FIRST QUALITY SERVICE
Entity Type:Organization
Organization Name:CHILDREN FIRST QUALITY SERVICE
Other - Org Name:CHILDREN FIRST QUALITY SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEME
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-313-4346
Mailing Address - Street 1:5345 CUMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4212
Mailing Address - Country:US
Mailing Address - Phone:678-698-5306
Mailing Address - Fax:
Practice Address - Street 1:5345 CUMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4212
Practice Address - Country:US
Practice Address - Phone:678-698-5306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 252Y00000X, 253Z00000X, 347C00000X
3746-226251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100073940Medicaid