Provider Demographics
NPI:1972045573
Name:QUALIFIED CARE PROVIDER INC
Entity Type:Organization
Organization Name:QUALIFIED CARE PROVIDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-741-4724
Mailing Address - Street 1:PO BOX 47216
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64188-7216
Mailing Address - Country:US
Mailing Address - Phone:877-741-4727
Mailing Address - Fax:844-674-4727
Practice Address - Street 1:10515 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-1918
Practice Address - Country:US
Practice Address - Phone:877-741-4727
Practice Address - Fax:844-674-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care