Provider Demographics
NPI:1003600800
Name:QUINCY MANOR LLC
Entity type:Organization
Organization Name:QUINCY MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:COSTOLINO
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:562-450-7211
Mailing Address - Street 1:115 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-2701
Mailing Address - Country:US
Mailing Address - Phone:313-106-3599
Mailing Address - Fax:
Practice Address - Street 1:115 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-2701
Practice Address - Country:US
Practice Address - Phone:313-106-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility