MEDICARE: QUALITY CARE NETWORK

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	251S00000X	Community/Behavioral Health Agency

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	:	1295925469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY CARE NETWORK

Provider Business Mailing Address
First Line	:	5326 E WASHINGTON ST BLDG B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2123
Country	:	US
Telephone Number	:	602-773-4900
Fax Number	:	602-773-4901

Provider Business Practice Location Address
First Line	:	5326 E WASHINGTON ST BLDG B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2123
Country	:	US
Telephone Number	:	602-773-4900
Fax Number	:	602-773-4901

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. GARY J BRENNAN
Credential	:	MS CHE
Telephone Number	:	602-773-4849

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	03/01/2010

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Directions to “QUALITY CARE NETWORK ” Practice Location

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