Qualicare Inc.

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

C132647 Issued in ID

Legal business name

QUALICARE INC.

Practice address

3539 Briar Creek LN
Suite a
Ammon, ID 83406-4761

Phone

(208) 542-1388

Fax

(208) 552-7847

NPI assigned

Dec 21, 2007

Organization subpart

No

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

Authorized official

Name

Bart O Larsen, LSW

Title

Owner/Manager

Phone

(208) 542-1388

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1629252994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3539 BRIAR CREEK LN",
            "address_2": "SUITE A",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064761",
            "telephone_number": "208-542-1388",
            "fax_number": "208-552-7847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3539 BRIAR CREEK LN",
            "address_2": "SUITE A",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064761",
            "telephone_number": "208-542-1388",
            "fax_number": "208-552-7847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALICARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-21",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "208-542-1388",
        "authorized_official_credential": "LSW"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "ID",
            "license": "C132647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8055151",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8058569",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8068114",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.