Healthcare Provider Details

I. General information

NPI: 1598641359
Provider Name (Legal Business Name): QUANTICO CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 OLYMPIC DR
STAFFORD VA
22554-7751
US

IV. Provider business mailing address

179 OLYMPIC DR
STAFFORD VA
22554-7751
US

V. Phone/Fax

Practice location:
  • Phone: 915-922-7586
  • Fax:
Mailing address:
  • Phone: 915-922-7586
  • 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 Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KARLA HERRERA
Title or Position: OWNER
Credential:
Phone: 915-922-7586