Provider Demographics
NPI:1639648603
Name:QUALITY HOME CARE LLC
Entity Type:Organization
Organization Name:QUALITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-707-7675
Mailing Address - Street 1:12639 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2232
Mailing Address - Country:US
Mailing Address - Phone:904-707-7675
Mailing Address - Fax:855-463-5928
Practice Address - Street 1:12639 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2232
Practice Address - Country:US
Practice Address - Phone:904-707-7675
Practice Address - Fax:855-463-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100858000Medicaid