Healthcare Provider Details

I. General information

NPI: 1881678886
Provider Name (Legal Business Name): CQI HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E WILSON AVE STE 230
GLENDALE CA
91206
US

IV. Provider business mailing address

520 E WILSON AVE STE 230
GLENDALE CA
91206
US

V. Phone/Fax

Practice location:
  • Phone: 818-549-4830
  • Fax: 818-549-4832
Mailing address:
  • Phone: 818-549-4830
  • Fax: 818-549-4832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateCA

VIII. Authorized Official

Name: NENA BASICAL VILLANIA
Title or Position: CEO ADMINISTRATOR
Credential: RN
Phone: 818-549-4830