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General NPI Number Information
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NPI Number | 1841859741
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Entity Type | Organization
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Legal Business Name | 21ST CENTURY QUALITY HOME CARE LLC
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 503 ROSEN AVE
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City | ARCOLA
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State | TX
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Zip | 77583-2752
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Country | US
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Telephone | 832-308-0776
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Fax |
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Provider Business Mailing Address
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Address Line | 503 ROSEN AVE
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City | ARCOLA
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State | TX
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Zip | 77583-2752
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Country | US
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Telephone | 832-308-0776
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | TIEASHA WADDY
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Credential |
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Telephone | 832-367-9087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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