Provider Demographics
NPI:1114679776
Name:QUALITY OF LIFE HOME
Entity Type:Organization
Organization Name:QUALITY OF LIFE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS-SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-248-2027
Mailing Address - Street 1:5412 GERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4330
Mailing Address - Country:US
Mailing Address - Phone:443-248-2027
Mailing Address - Fax:
Practice Address - Street 1:5217 1/2 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4219
Practice Address - Country:US
Practice Address - Phone:667-910-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children