=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649670928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QOC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 CHUCK DR
-----------------------------------------------------
City | FRIENDSWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77546-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-319-7875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1214 CHUCK DR
-----------------------------------------------------
City | FRIENDSWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77546-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-319-7875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANKOMA TAPLET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-319-7875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------