Healthcare Provider Details

I. General information

NPI: 1700148467
Provider Name (Legal Business Name): FSQC-AL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2184 PARKWAY LAKE DR
HOOVER AL
35244-1803
US

IV. Provider business mailing address

400 CENTRE ST
NEWTON MA
02458-2094
US

V. Phone/Fax

Practice location:
  • Phone: 205-403-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: BRUCE J MACKEY JR.
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8214