Provider Demographics
NPI:1356923502
Name:QUALITY CARE SERVICES OF NW FL LLC
Entity type:Organization
Organization Name:QUALITY CARE SERVICES OF NW FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNWE
Authorized Official - Phone:850-557-0664
Mailing Address - Street 1:2914 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3334
Mailing Address - Country:US
Mailing Address - Phone:850-557-0664
Mailing Address - Fax:
Practice Address - Street 1:2914 GREEN ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3334
Practice Address - Country:US
Practice Address - Phone:850-557-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL674068596Medicaid