Provider Demographics
NPI:1912178070
Name:QUALITY CARE SITTER, COMPANION, HOMEHEALTH, HOSPICE AGENCY L.L.C
Entity Type:Organization
Organization Name:QUALITY CARE SITTER, COMPANION, HOMEHEALTH, HOSPICE AGENCY L.L.C
Other - Org Name:& INDEPENDENT GROUP HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHAINE
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PATIENT CARE TECH
Authorized Official - Phone:769-233-3870
Mailing Address - Street 1:4548 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5335
Mailing Address - Country:US
Mailing Address - Phone:769-233-3870
Mailing Address - Fax:
Practice Address - Street 1:4548 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5335
Practice Address - Country:US
Practice Address - Phone:769-233-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp