Provider Demographics
NPI:1104101682
Name:QCS LLC
Entity type:Organization
Organization Name:QCS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSS GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-295-8931
Mailing Address - Street 1:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23705
Mailing Address - Country:US
Mailing Address - Phone:757-295-8931
Mailing Address - Fax:757-282-2990
Practice Address - Street 1:1109 EDEN SQ OFC PARK
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2750
Practice Address - Country:US
Practice Address - Phone:757-295-8931
Practice Address - Fax:757-282-2990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALITY COMMUNITY SUPPORTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-17
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA460-03-001253Z00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care