Healthcare Provider Details

I. General information

NPI: 1457893422
Provider Name (Legal Business Name): QCC-QUALITY GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4946 E YALE AVE STE 103
FRESNO CA
93727-1571
US

IV. Provider business mailing address

4946 E YALE AVE STE 103
FRESNO CA
93727-1571
US

V. Phone/Fax

Practice location:
  • Phone: 559-458-0210
  • Fax:
Mailing address:
  • Phone: 559-458-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ALTON DUKE DOULPHUS
Title or Position: DIRECTOR
Credential:
Phone: 559-250-5885