Healthcare Provider Details

I. General information

NPI: 1699475327
Provider Name (Legal Business Name): QUANTUM HOUSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 WILSHIRE BLVD STE 1753
LOS ANGELES CA
90017-2606
US

IV. Provider business mailing address

811 WILSHIRE BLVD STE 1700
LOS ANGELES CA
90017-2630
US

V. Phone/Fax

Practice location:
  • Phone: 213-342-5640
  • Fax:
Mailing address:
  • Phone: 213-342-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNICUS L COOK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-342-5640