Provider Demographics
NPI:1689200065
Name:SPECIALIZED QUALITY CARE LLC
Entity Type:Organization
Organization Name:SPECIALIZED QUALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:609-314-8568
Mailing Address - Street 1:76 ELDERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2418
Mailing Address - Country:US
Mailing Address - Phone:609-314-8568
Mailing Address - Fax:
Practice Address - Street 1:811 CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1412
Practice Address - Country:US
Practice Address - Phone:609-314-8568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child