Provider Demographics
NPI:1447815659
Name:QUINN COMMUNITY OUTREACH CORPORATION
Entity type:Organization
Organization Name:QUINN COMMUNITY OUTREACH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EUDORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-570-0043
Mailing Address - Street 1:25400 ALESSANDRO BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4319
Mailing Address - Country:US
Mailing Address - Phone:951-570-0043
Mailing Address - Fax:
Practice Address - Street 1:25400 ALESSANDRO BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4319
Practice Address - Country:US
Practice Address - Phone:951-570-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization