Provider Demographics
NPI:1407971898
Name:QUALITY INDEPENDENT SERVICE COORDINATORS
Entity Type:Organization
Organization Name:QUALITY INDEPENDENT SERVICE COORDINATORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:T
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-858-9370
Mailing Address - Street 1:2322 ASCOTT PL
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4502
Mailing Address - Country:US
Mailing Address - Phone:901-531-7350
Mailing Address - Fax:901-531-7352
Practice Address - Street 1:2322 ASCOTT PL
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4502
Practice Address - Country:US
Practice Address - Phone:901-531-7350
Practice Address - Fax:901-531-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00E01Medicaid