Provider Demographics
NPI:1902074263
Name:QUALITY CARE HOME CARE
Entity Type:Organization
Organization Name:QUALITY CARE HOME CARE
Other - Org Name:QUALITY CARE HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:MONTALEDO
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-271-4485
Mailing Address - Street 1:PO BOX 9848
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-9327
Mailing Address - Country:US
Mailing Address - Phone:864-271-4485
Mailing Address - Fax:864-271-4565
Practice Address - Street 1:1 CHICK SPRINGS RD
Practice Address - Street 2:SUITE 103-A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4946
Practice Address - Country:US
Practice Address - Phone:864-271-4485
Practice Address - Fax:864-271-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0778Medicaid