Healthcare Provider Details

I. General information

NPI: 1538096201
Provider Name (Legal Business Name): QUALITY CARE RESIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 E 112TH ST
CLEVELAND OH
44108-1406
US

IV. Provider business mailing address

21271 CRYSTAL AVE
EUCLID OH
44123-2123
US

V. Phone/Fax

Practice location:
  • Phone: 216-333-6053
  • Fax:
Mailing address:
  • Phone: 216-333-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAYLE DANIELLE GORDON
Title or Position: OWNER
Credential:
Phone: 216-333-6053