Provider Demographics
NPI:1447505649
Name:QOACHLLC
Entity type:Organization
Organization Name:QOACHLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-775-7658
Mailing Address - Street 1:3872 BRAYTON MOUNTAIN RD.
Mailing Address - Street 2:
Mailing Address - City:GRAYSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37338-5123
Mailing Address - Country:US
Mailing Address - Phone:423-775-7658
Mailing Address - Fax:423-775-0366
Practice Address - Street 1:3872 BRAYTON MOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:GRAYSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37338-5123
Practice Address - Country:US
Practice Address - Phone:423-775-7658
Practice Address - Fax:423-775-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2023-02-13
Deactivation Date:2023-01-30
Deactivation Code:
Reactivation Date:2023-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020512Medicaid