Quincy Eugene McCullough

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

361800175 Issued in CA

Practice address

15693 Choctaw St
Victorville, CA 92395-5531

Phone

(442) 229-2100

Fax

(442) 229-2100

NPI assigned

Oct 22, 2020

Last updated

Oct 22, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1184223943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15693 CHOCTAW ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955531",
            "telephone_number": "442-229-2100",
            "fax_number": "442-229-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15693 CHOCTAW ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955531",
            "telephone_number": "442-229-2100",
            "fax_number": "442-229-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "QUINCY",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "361800175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael McConnell, D.O.
• Charles Keith McCord, P.A.
• Miranda McCormack
• Nimi McCoy, RPH
• Jada Rayshill McCullough
• Antoinette McCully
• Brody M McDonagh
• Conswalo McDonald
• Dale McDonald
• Melanie McDonald, F.N.P.

• Assisted Living Facility in Victorville, CA
• Providers in Victorville, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.