=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306273305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY RESIDENTIAL ALTERNATIVES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2013
-----------------------------------------------------
Last Update Date | 10/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8535 N DIXIE DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45414-2491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-454-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 217
-----------------------------------------------------
City | GRATIOT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43740-0217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-787-5007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. REBECCA WARNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-454-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------