Healthcare Provider Details

I. General information

NPI: 1952672818
Provider Name (Legal Business Name): QUALITY COMMUNITY SUPPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 EDEN SQ OFC PARK
CHESAPEAKE VA
23320-2750
US

IV. Provider business mailing address

PO BOX 1072
PORTSMOUTH VA
23705-1072
US

V. Phone/Fax

Practice location:
  • Phone: 757-295-8931
  • Fax: 757-282-2990
Mailing address:
  • Phone: 757-295-8931
  • Fax: 757-282-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number460-03-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number460-05-001
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number460-03-001
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number460-01-001
License Number StateVA

VIII. Authorized Official

Name: SEBRINA PORTER
Title or Position: PRESIDENT
Credential:
Phone: 757-650-8878