Provider Demographics
NPI:1912542937
Name:QUALICARE FAMILY HOMECARE
Entity Type:Organization
Organization Name:QUALICARE FAMILY HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-213-1454
Mailing Address - Street 1:2103 S EL CAMINO REAL STE 204
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6281
Mailing Address - Country:US
Mailing Address - Phone:760-936-4000
Mailing Address - Fax:760-936-4044
Practice Address - Street 1:2103 S EL CAMINO REAL STE 204
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6281
Practice Address - Country:US
Practice Address - Phone:760-936-4000
Practice Address - Fax:760-936-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty