MEDICARE: PALM QUALITY CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215407234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM QUALITY CARE INC

Provider Business Mailing Address
First Line	:	4650 LIPSCOMB ST NE STE 28
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2997
Country	:	US
Telephone Number	:	321-215-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 LIPSCOMB ST NE STE 28
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2997
Country	:	US
Telephone Number	:	321-290-9455
Fax Number	:	321-821-4596

Authorized Official
Title or Position	:	CEO
Name	:	IMATIDE CHARLES
Credential	:
Telephone Number	:	321-215-1131

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	03/06/2024

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