Provider Demographics
NPI:1063849693
Name:LIFEQUEST DISABILITIES SERVICES, INC.
Entity Type:Organization
Organization Name:LIFEQUEST DISABILITIES SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA/QP
Authorized Official - Phone:910-430-4152
Mailing Address - Street 1:199 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-9376
Mailing Address - Country:US
Mailing Address - Phone:910-430-4152
Mailing Address - Fax:910-430-4153
Practice Address - Street 1:603 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5432
Practice Address - Country:US
Practice Address - Phone:910-430-4152
Practice Address - Fax:910-431-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC516035OtherTRICARE NORTH