1710060553 NPI number — QUALITY LIFE ASSISTANCE SERVICES, INC

Table of content: (NPI 1710060553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710060553 NPI number — QUALITY LIFE ASSISTANCE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY LIFE ASSISTANCE SERVICES, 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:
1710060553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-1298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-738-8122
Provider Business Mailing Address Fax Number:
787-738-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 735
Provider Second Line Business Practice Location Address:
DETRAS RADAR ATT
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-738-8122
Provider Business Practice Location Address Fax Number:
787-738-2700
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
CASTRODAD
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-738-8122

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TCAMB 431 . This is a "COMISION SERVICIO PUBLICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com