Healthcare Provider Details

I. General information

NPI: 1023595550
Provider Name (Legal Business Name): QUALITY CARE III , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 CANDACE RIDGE DR
GREENSBORO NC
27406-8595
US

IV. Provider business mailing address

1594 CANDACE RIDGE DR
GREENSBORO NC
27406-8595
US

V. Phone/Fax

Practice location:
  • Phone: 336-558-1742
  • Fax:
Mailing address:
  • Phone: 336-558-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD ANTHONY BENJAMIN
Title or Position: OWNER
Credential:
Phone: 336-558-1742