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NPI Code Detail

MEDICARE: QUALITY INDEPENDENT CARE

MEDICARE: QUALITY INDEPENDENT CARE
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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1366724700
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUALITY INDEPENDENT CARE
Provider Business Mailing Address
First Line : 2353 MOONLITE DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-5305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6298 MESOSPHERE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-5043
Country : US
Telephone Number : 702-400-3819
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. JON RICHARD WATASE
Credential :
Telephone Number : 702-400-3819
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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Directions to “QUALITY INDEPENDENT CARE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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