Provider Demographics
NPI:1124236195
Name:QUALITY CHAIRVAN SERVICE
Entity type:Organization
Organization Name:QUALITY CHAIRVAN SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-793-9000
Mailing Address - Street 1:25 TOWN FOREST RD # A
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-2845
Mailing Address - Country:US
Mailing Address - Phone:508-793-9000
Mailing Address - Fax:508-987-2318
Practice Address - Street 1:25 TOWN FOREST RD # A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-2845
Practice Address - Country:US
Practice Address - Phone:508-793-9000
Practice Address - Fax:508-987-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1715518343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1700316Medicaid
MAAM0222Medicare ID - Type Unspecified