Healthcare Provider Details

I. General information

NPI: 1568818193
Provider Name (Legal Business Name): QUICK SUPPORTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 WILKES DR
GREEN RIVER WY
82935-5037
US

IV. Provider business mailing address

755 WILKES DR
GREEN RIVER WY
82935-5037
US

V. Phone/Fax

Practice location:
  • Phone: 307-871-2864
  • Fax:
Mailing address:
  • Phone: 307-871-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA R. QUICK
Title or Position: PRESIDENT
Credential:
Phone: 307-871-2864