Provider Demographics
NPI:1700060290
Name:CQI HOMECARE INC
Entity type:Organization
Organization Name:CQI HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NENA
Authorized Official - Middle Name:BASICAL
Authorized Official - Last Name:VILLANIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA
Authorized Official - Phone:818-549-4830
Mailing Address - Street 1:520 E WILSON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4374
Mailing Address - Country:US
Mailing Address - Phone:818-549-4830
Mailing Address - Fax:818-548-4832
Practice Address - Street 1:520 E WILSON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4374
Practice Address - Country:US
Practice Address - Phone:818-549-4830
Practice Address - Fax:818-548-4832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CQI HOMECARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE058119OtherMEDIARE PROVIDER NUMBER
DEHHA-08118FOtherMEDICAL PROVIDER NUMBER