Provider Demographics
NPI:1497527048
Name:QUALITY OF LIFE RESOURCE AND REFERRAL LLC
Entity Type:Organization
Organization Name:QUALITY OF LIFE RESOURCE AND REFERRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON-DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-341-1764
Mailing Address - Street 1:4213 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-6809
Mailing Address - Country:US
Mailing Address - Phone:252-341-1764
Mailing Address - Fax:252-379-0428
Practice Address - Street 1:601 COUNTRY CLUB DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6124
Practice Address - Country:US
Practice Address - Phone:252-341-1764
Practice Address - Fax:252-379-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCADC-21211OtherSUBSTANCE ABUSE COUNSELOR INTERN