Provider Demographics
NPI: | 1700243508 |
---|---|
Name: | QUALITY CARE FIRST ASSIST, INC. |
Entity Type: | Organization |
Organization Name: | QUALITY CARE FIRST ASSIST, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BEVERLY |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | ROSALES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSN, FNP-C |
Authorized Official - Phone: | 480-212-2011 |
Mailing Address - Street 1: | 4647 E BUCKBOARD CT |
Mailing Address - Street 2: | |
Mailing Address - City: | GILBERT |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85297-5524 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-212-2011 |
Mailing Address - Fax: | 480-279-9899 |
Practice Address - Street 1: | 4647 E BUCKBOARD CT |
Practice Address - Street 2: | |
Practice Address - City: | GILBERT |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85297-5524 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-212-2011 |
Practice Address - Fax: | 480-279-9899 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-01-25 |
Last Update Date: | 2016-01-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |