Provider Demographics
NPI:1275969172
Name:LIFE QUALITY HEALTH CARE
Entity Type:Organization
Organization Name:LIFE QUALITY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WINGARD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-458-4601
Mailing Address - Street 1:4265 DUCK CLUB RD
Mailing Address - Street 2:
Mailing Address - City:RAVENEL
Mailing Address - State:SC
Mailing Address - Zip Code:29470-3318
Mailing Address - Country:US
Mailing Address - Phone:843-501-0211
Mailing Address - Fax:888-887-5076
Practice Address - Street 1:4265 DUCK CLUB RD
Practice Address - Street 2:
Practice Address - City:RAVENEL
Practice Address - State:SC
Practice Address - Zip Code:29470-3318
Practice Address - Country:US
Practice Address - Phone:843-501-0211
Practice Address - Fax:888-887-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care