Healthcare Provider Details

I. General information

NPI: 1689200065
Provider Name (Legal Business Name): SPECIALIZED QUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 CHURCH RD
CHERRY HILL NJ
08002-1412
US

IV. Provider business mailing address

76 ELDERBERRY LN
WILLINGBORO NJ
08046-2418
US

V. Phone/Fax

Practice location:
  • Phone: 609-314-8568
  • Fax:
Mailing address:
  • Phone: 609-314-8568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TASHELLE L BALL
Title or Position: FOUNDER/OWNER
Credential: MBA
Phone: 609-314-8568