Provider Demographics
NPI:1790476919
Name:QUALITY CARE CLINIC LLC
Entity Type:Organization
Organization Name:QUALITY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:203-871-1953
Mailing Address - Street 1:1371 BOSTON POST ROAD, #1061
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-871-1953
Mailing Address - Fax:
Practice Address - Street 1:1371 BOSTON POST ROAD, #1061
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-871-1953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty