MEDICARE: TOTAL QUALITY RESIDENTIAL SERVICES, INC.

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	1223-14-001	VA
2	251C00000X	Developmentally Disabled Services Day Training Agency	1223-14-001	VA
3	323P00000X	Psychiatric Residential Treatment Facility	1223-14-001	VA

General Provider Information

NPI Number	:	1114175387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL QUALITY RESIDENTIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	4121 SIHLER OAKS TRL
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5004
Country	:	US
Telephone Number	:	410-802-3815
Fax Number	:	443-703-2331

Provider Business Practice Location Address
First Line	:	225 S WHITING ST APT 124
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-7117
Country	:	US
Telephone Number	:	410-802-3815
Fax Number	:	443-703-2331

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MR. DARREN LAMONT PURNELL
Credential	:
Telephone Number	:	410-802-3815

Provider Enumeration Date	:	08/30/2008
Last Update Date	:	08/09/2010

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