1932110384 NPI number — QUALITY LIFE HOME CARE, 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 1932110384 NPI number — QUALITY LIFE HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY LIFE HOME CARE, 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:
1932110384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1892
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27312-1892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-545-2027
Provider Business Mailing Address Fax Number:
919-545-2029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 EAST ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
PITTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-545-2027
Provider Business Practice Location Address Fax Number:
919-545-2029
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
BELTON
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
919-545-2027

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC3369 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100587 . This is a "PDN PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3418151 . This is a "CAP PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6601488 . This is a "PCS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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