1609104439 NPI number — QUALITY CARE PL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609104439 NPI number — QUALITY CARE PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY CARE PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609104439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
678 WASHINGTON ST
Provider Second Line Business Mailing Address:
APT.#515
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01901-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 S OCEAN DR STE G3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33019-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-548-7160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORLOV
Authorized Official First Name:
MICHAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
617-548-7160

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  94460 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)