Provider Demographics
NPI:1306873351
Name:QUINCY HOME MEDICAL SERVICES
Entity type:Organization
Organization Name:QUINCY HOME MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BREST-LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-283-9787
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-0377
Mailing Address - Country:US
Mailing Address - Phone:530-283-9787
Mailing Address - Fax:
Practice Address - Street 1:211 LAWRENCE ST.
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-0377
Practice Address - Country:US
Practice Address - Phone:530-283-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08258FMedicaid
CA05-8258Medicare ID - Type UnspecifiedHOME HEALTH AGENCY