Provider Demographics
NPI:1649691965
Name:QUALITY PROVIDER CARE SERVICE
Entity type:Organization
Organization Name:QUALITY PROVIDER CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICER
Authorized Official - Phone:713-998-6162
Mailing Address - Street 1:19830 BRAECOVE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4072
Mailing Address - Country:US
Mailing Address - Phone:713-998-6162
Mailing Address - Fax:
Practice Address - Street 1:19830 BRAECOVE CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4072
Practice Address - Country:US
Practice Address - Phone:713-998-6162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-05
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty