Provider Demographics
NPI:1962968438
Name:QUALITY CARE RESIDENTIAL HOMES
Entity type:Organization
Organization Name:QUALITY CARE RESIDENTIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SANDRALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-938-6189
Mailing Address - Street 1:4110 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-2224
Mailing Address - Country:US
Mailing Address - Phone:480-938-6189
Mailing Address - Fax:
Practice Address - Street 1:4110 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2224
Practice Address - Country:US
Practice Address - Phone:480-938-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness