Provider Demographics
NPI:1194988568
Name:QUALITY CARE ADULT DAY HABILITATION
Entity type:Organization
Organization Name:QUALITY CARE ADULT DAY HABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-716-3627
Mailing Address - Street 1:135A WALKER PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1485
Mailing Address - Country:US
Mailing Address - Phone:770-716-3627
Mailing Address - Fax:770-716-3672
Practice Address - Street 1:135A WALKER PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1485
Practice Address - Country:US
Practice Address - Phone:770-716-3627
Practice Address - Fax:770-716-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA604705391AMedicaid