Provider Demographics
NPI:1952502114
Name:QUALITY SUPPORT COORDINATION INC
Entity Type:Organization
Organization Name:QUALITY SUPPORT COORDINATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:T
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-858-9370
Mailing Address - Street 1:2800 YOUREE DR BLDG A-380
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3661
Mailing Address - Country:US
Mailing Address - Phone:318-219-2514
Mailing Address - Fax:318-219-8642
Practice Address - Street 1:2800 YOUREE DR BLDG A-380
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3661
Practice Address - Country:US
Practice Address - Phone:318-219-2514
Practice Address - Fax:318-219-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7295251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548111Medicaid