MEDICARE: QUALITY COMMUNITY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1073345419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY COMMUNITY SERVICES, LLC

Provider Business Mailing Address
First Line	:	5743 DARIEN DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3046
Country	:	US
Telephone Number	:	334-224-4650
Fax Number	:	334-416-8035

Provider Business Practice Location Address
First Line	:	5743 DARIEN DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3046
Country	:	US
Telephone Number	:	334-224-4650
Fax Number	:	334-416-8035

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERESA MCCALL
Credential	:	PHD
Telephone Number	:	334-224-4650

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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