Provider Demographics
NPI:1295233112
Name:QUALITY SENIOR CARE, LLC
Entity type:Organization
Organization Name:QUALITY SENIOR CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-842-7540
Mailing Address - Street 1:1034 SEARCY WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7164
Mailing Address - Country:US
Mailing Address - Phone:270-842-7540
Mailing Address - Fax:270-842-7436
Practice Address - Street 1:756 RIVERGATE PKWY
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2321
Practice Address - Country:US
Practice Address - Phone:615-859-2380
Practice Address - Fax:270-842-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000940362OtherSECRETARY OF STATE NUMBER