Individual provider · NPI-1

Ahmed Awad Qasim

Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Riverside, CA

NPI number1952995086
StatusActive
Last updated in NPPESMar 16, 2021

Details

NPI
1952995086
Entity type
Individual (NPI-1)
Name
Ahmed Awad Qasim
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 1, 2021
Certification date
Mar 16, 2021
Last updated
Mar 16, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities331881116CAYes
311ZA0620X Custodial Care Facility, Adult Care Home––

Practice location

11545 Doverwood Dr
Riverside, CA 92505-3205

Phone 650-452-2554

Mailing address

11545 Doverwood Dr
Riverside, CA 92505-3205

Phone 650-452-2554

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