Provider Demographics
NPI:1639546864
Name:INDEPENDENT QUALITY SERVICES INC
Entity Type:Organization
Organization Name:INDEPENDENT QUALITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CEO/PROGRAM SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALIE
Authorized Official - Middle Name:BOMBOLAI
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:267-449-9976
Mailing Address - Street 1:6152 KINGSESSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2426
Mailing Address - Country:US
Mailing Address - Phone:267-449-9976
Mailing Address - Fax:
Practice Address - Street 1:6152 KINGSESSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2426
Practice Address - Country:US
Practice Address - Phone:267-449-9976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARENT ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities