=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144412842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2007
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 BROADMOOR DR
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72204-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-0899
-----------------------------------------------------
Fax | 501-569-9874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 BROADMOOR DR
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72204-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-0899
-----------------------------------------------------
Fax | 501-569-9874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPN
-----------------------------------------------------
Name | PAULINE OKWUOSA
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 501-664-0899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------