1144815507 NPI number — QUALITY LIFE CARE HOME HEALTH INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144815507 NPI number — QUALITY LIFE CARE HOME HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY LIFE CARE HOME HEALTH INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144815507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 VISTA PKWY STE 275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33411-2706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-635-1197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 VISTA PKWY STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-635-1197
Provider Business Practice Location Address Fax Number:
877-788-0285
Provider Enumeration Date:
03/07/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FROMETA
Authorized Official First Name:
AYMEE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR, PRESIDENT
Authorized Official Telephone Number:
561-635-1197

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 299995321 . This is a "STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 115561800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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