Provider Demographics
NPI:1205461696
Name:QUAYLE INTERVENTIONAL SERVICES
Entity type:Organization
Organization Name:QUAYLE INTERVENTIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAZEMORE QUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, CFNC, CEAP, SAP
Authorized Official - Phone:443-636-0686
Mailing Address - Street 1:5041 W NORTHERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1539
Mailing Address - Country:US
Mailing Address - Phone:480-508-1077
Mailing Address - Fax:
Practice Address - Street 1:5041 W NORTHERN AVE STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1539
Practice Address - Country:US
Practice Address - Phone:480-508-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No253J00000XAgenciesFoster Care AgencyGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care