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General NPI Number Information
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NPI Number | 1104101682
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Entity Type | Organization
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Legal Business Name | QCS LLC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 1109 EDEN SQ OFC PARK
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2750
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Country | US
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Telephone | 757-295-8931
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Fax | 757-282-2990
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Provider Business Mailing Address
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Address Line | PO BOX 1072
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City | PORTSMOUTH
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State | VA
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Zip | 23705
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Country | US
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Telephone | 757-295-8931
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Fax | 757-282-2990
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLORIA A GROSS GREEN
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Credential |
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Telephone | 757-295-8931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 460-03-001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 460-03-001
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License Number State | VA
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