Healthcare Provider Details

I. General information

NPI: 1114175387
Provider Name (Legal Business Name): TOTAL QUALITY RESIDENTIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2008
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S WHITING ST APT 124
ALEXANDRIA VA
22304-7117
US

IV. Provider business mailing address

4121 SIHLER OAKS TRL
OWINGS MILLS MD
21117-5004
US

V. Phone/Fax

Practice location:
  • Phone: 410-802-3815
  • Fax: 443-703-2331
Mailing address:
  • Phone: 410-802-3815
  • Fax: 443-703-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1223-14-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1223-14-001
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number1223-14-001
License Number StateVA

VIII. Authorized Official

Name: MR. DARREN LAMONT PURNELL
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 410-802-3815