Provider Demographics
NPI:1023441482
Name:QUALITY CARE GROUP HOME INC
Entity type:Organization
Organization Name:QUALITY CARE GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-478-7808
Mailing Address - Street 1:16151 CAIRNWAY DR STE 107A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3554
Mailing Address - Country:US
Mailing Address - Phone:413-478-7808
Mailing Address - Fax:281-556-4344
Practice Address - Street 1:16151 CAIRNWAY DR STE 107A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3554
Practice Address - Country:US
Practice Address - Phone:413-478-7808
Practice Address - Fax:281-556-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000000Medicaid