Provider Demographics
NPI:1467787481
Name:QUALITYLIFE HEALTHCARE,LLC
Entity Type:Organization
Organization Name:QUALITYLIFE HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OMODARA
Authorized Official - Last Name:ADEMIJU
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:708-331-4214
Mailing Address - Street 1:15525 S PARK AVE
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1308
Mailing Address - Country:US
Mailing Address - Phone:708-331-4214
Mailing Address - Fax:708-331-4216
Practice Address - Street 1:15525 S PARK AVE
Practice Address - Street 2:SUITE 103A
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1308
Practice Address - Country:US
Practice Address - Phone:708-331-4214
Practice Address - Fax:708-331-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010971251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health