1154508562 NPI number — QUALITY LIVING SUPPORT,INC

Table of content: (NPI 1154508562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154508562 NPI number — QUALITY LIVING SUPPORT,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY LIVING SUPPORT,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:
QUALITY LIVING SPPORT,INC.
Provider Other Organization Name Type Code:
3
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:
1154508562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3231 OLD WINTER GARDEN RD
Provider Second Line Business Mailing Address:
U6-1
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32805-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-376-8488
Provider Business Mailing Address Fax Number:
407-297-8335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3231 OLD WINTER GARDEN RD
Provider Second Line Business Practice Location Address:
U6-1
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32805-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-376-8488
Provider Business Practice Location Address Fax Number:
407-297-8335
Provider Enumeration Date:
01/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-376-8488

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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