1790922672 NPI number — QUALITY OF LIFE HEALTH SERVICES INC.

Table of content: BERTHA I BUSTOS RN, CDE (NPI 1760897524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790922672 NPI number — QUALITY OF LIFE HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY OF LIFE HEALTH 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:
6
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:
1790922672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35902-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 TUSCALOOSA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35901-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-439-6402
Provider Business Practice Location Address Fax Number:
256-492-9147
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
DERRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
256-439-6402

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  113224 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0135788 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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