Provider Demographics
NPI:1407514151
Name:QUALITY HOME CARE STAFFING SERVICE
Entity Type:Organization
Organization Name:QUALITY HOME CARE STAFFING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARAVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-235-4677
Mailing Address - Street 1:258 MCKINLEY
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-235-4677
Mailing Address - Fax:208-235-3736
Practice Address - Street 1:258 MCKINLEY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-235-4677
Practice Address - Fax:208-235-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty