Provider Demographics
NPI:1265780308
Name:TQN CAP SERVICES
Entity type:Organization
Organization Name:TQN CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PERNELL
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-378-9415
Mailing Address - Street 1:2300 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3720
Mailing Address - Country:US
Mailing Address - Phone:336-378-9415
Mailing Address - Fax:336-378-9417
Practice Address - Street 1:2300 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 117
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3720
Practice Address - Country:US
Practice Address - Phone:336-378-9415
Practice Address - Fax:336-378-9417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWIN QUALITY NURSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3733251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418909Medicaid