Healthcare Provider Details

I. General information

NPI: 1154130235
Provider Name (Legal Business Name): TOTAL QUALITY TRANS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SCARLET OAK ST APT 102
SOUTHAVEN MS
38671-6329
US

IV. Provider business mailing address

700 SCARLET OAK ST APT 102
SOUTHAVEN MS
38671-6329
US

V. Phone/Fax

Practice location:
  • Phone: 813-774-9494
  • Fax:
Mailing address:
  • Phone: 813-774-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: IDRISSA LO
Title or Position: OWNER
Credential:
Phone: 813-774-9494