Provider Demographics
NPI:1154508562
Name:QUALITY LIVING SUPPORT,INC
Entity Type:Organization
Organization Name:QUALITY LIVING SUPPORT,INC
Other - Org Name:QUALITY LIVING SPPORT,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-376-8488
Mailing Address - Street 1:3231 OLD WINTER GARDEN RD
Mailing Address - Street 2:U6-1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1104
Mailing Address - Country:US
Mailing Address - Phone:407-376-8488
Mailing Address - Fax:407-297-8335
Practice Address - Street 1:3231 OLD WINTER GARDEN RD
Practice Address - Street 2:U6-1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1104
Practice Address - Country:US
Practice Address - Phone:407-376-8488
Practice Address - Fax:407-297-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health