Healthcare Provider Details

I. General information

NPI: 1326405416
Provider Name (Legal Business Name): QUALITY CORRECTIONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 N MERIDIAN ST STE 140
CARMEL IN
46032-5401
US

IV. Provider business mailing address

400 W AIR PARK DR
MUNCIE IN
47303-1886
US

V. Phone/Fax

Practice location:
  • Phone: 765-749-5290
  • Fax:
Mailing address:
  • Phone: 765-749-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORA SORRELL
Title or Position: DIRECTOR
Credential:
Phone: 765-749-5290