Provider Demographics
NPI:1992793129
Name:QUALITY LONG TERM CARE MANAGEMENT
Entity type:Organization
Organization Name:QUALITY LONG TERM CARE MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-9124
Mailing Address - Street 1:1836 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1619
Mailing Address - Country:US
Mailing Address - Phone:626-798-9124
Mailing Address - Fax:626-794-2964
Practice Address - Street 1:1836 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1619
Practice Address - Country:US
Practice Address - Phone:626-798-9124
Practice Address - Fax:626-794-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC55338G314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55338GMedicaid
CALTC55338GMedicaid