MEDICARE: QUALITY INDEPENDENT CARE

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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265860399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY INDEPENDENT CARE

Provider Business Mailing Address
First Line	:	10332 HORSEBACK RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6867
Country	:	US
Telephone Number	:	702-445-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	10332 HORSEBACK RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6867
Country	:	US
Telephone Number	:	702-445-1360
Fax Number	:

Authorized Official
Title or Position	:	QUALIFIED BEHAVIORAL AID
Name	:	D-ANA LYNN HERNANDEZ
Credential	:
Telephone Number	:	702-445-1360

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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Directions to “QUALITY INDEPENDENT CARE ” Practice Location

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