Provider Demographics
NPI:1861536518
Name:A1 QUALITY HOMECARE PROVIDER, INC,
Entity type:Organization
Organization Name:A1 QUALITY HOMECARE PROVIDER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:SECADES
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-845-8038
Mailing Address - Street 1:1710 DESERT ALMOND WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8611
Mailing Address - Country:US
Mailing Address - Phone:951-845-8038
Mailing Address - Fax:951-848-6288
Practice Address - Street 1:1710 DESERT ALMOND WAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8611
Practice Address - Country:US
Practice Address - Phone:951-845-8038
Practice Address - Fax:951-848-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03349171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty