Provider Demographics
NPI:1992023436
Name:QUILLEN ENTERPRISES, INC.
Entity Type:Organization
Organization Name:QUILLEN ENTERPRISES, INC.
Other - Org Name:AT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-218-8157
Mailing Address - Street 1:2025-C MARTIN LUTHER KING JR. DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406
Mailing Address - Country:US
Mailing Address - Phone:336-218-8757
Mailing Address - Fax:336-510-1499
Practice Address - Street 1:2025-C MARTIN LUTHER KING JR. DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406
Practice Address - Country:US
Practice Address - Phone:336-218-8757
Practice Address - Fax:336-510-1499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUILLEN ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4073251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health