Provider Demographics
NPI:1639824220
Name:QUALITY PROFESSIONAL CARE, INC
Entity Type:Organization
Organization Name:QUALITY PROFESSIONAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-686-5121
Mailing Address - Street 1:PO BOX 352034
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32235-2034
Mailing Address - Country:US
Mailing Address - Phone:904-686-5121
Mailing Address - Fax:
Practice Address - Street 1:2962 BRIGHT EAGLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-5044
Practice Address - Country:US
Practice Address - Phone:904-686-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities