Healthcare Provider Details

I. General information

NPI: 1316631880
Provider Name (Legal Business Name): QUALITY CARE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 W PEORIA AVE STE 101
GLENDALE AZ
85302-1301
US

IV. Provider business mailing address

5820 W PEORIA AVE STE 101
GLENDALE AZ
85302-1301
US

V. Phone/Fax

Practice location:
  • Phone: 646-982-9635
  • Fax:
Mailing address:
  • Phone: 646-982-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YAYAH JUSU
Title or Position: OWNER
Credential:
Phone: 646-982-9635