=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033597935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUINN QUALITY HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2015
-----------------------------------------------------
Last Update Date | 05/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 887 LAKE RIDGE DR APT 2A
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38671-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-374-6394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 887 LAKE RIDGE DR APT 2A
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38671-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-374-6394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DENITA QUINN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 662-374-6394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R891158
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------