Provider Demographics
NPI:1700212180
Name:QUALITY CARE TRANSPORTATION
Entity Type:Organization
Organization Name:QUALITY CARE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AVIAR
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-450-8404
Mailing Address - Street 1:5875 MISSION BLVD APT 150
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4284
Mailing Address - Country:US
Mailing Address - Phone:951-534-8404
Mailing Address - Fax:951-534-8404
Practice Address - Street 1:5875 MISSION BLVD APT 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-4284
Practice Address - Country:US
Practice Address - Phone:951-534-8404
Practice Address - Fax:951-534-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN00915F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00915FMedicaid