Healthcare Provider Details

I. General information

NPI: 1225071996
Provider Name (Legal Business Name): QUALITY CARE MANAGEMENT OF N CENTRAL FLORIDA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SAINT JOHNS AVE SUITE # 209
PALATKA FL
32177-4643
US

IV. Provider business mailing address

613 SAINT JOHNS AVE SUITE 209
PALATKA FL
32177-4643
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-0314
  • Fax: 386-325-0137
Mailing address:
  • Phone: 386-325-0314
  • Fax: 386-325-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LOLETHER ELESTER CROOMS
Title or Position: ASST. ADMINISTRATOR
Credential: LPN
Phone: 386-325-0314