Healthcare Provider Details

I. General information

NPI: 1124676259
Provider Name (Legal Business Name): QUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 09/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MEAD ST
RACINE WI
53403
US

IV. Provider business mailing address

2051 MEAD ST
RACINE WI
53403
US

V. Phone/Fax

Practice location:
  • Phone: 262-664-0607
  • Fax: 262-554-6024
Mailing address:
  • Phone: 262-664-0607
  • Fax: 262-554-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ILENE A ZINN
Title or Position: LICENSEE
Credential:
Phone: 262-664-0607