Provider Demographics
NPI:1558947531
Name:QLIFE
Entity Type:Organization
Organization Name:QLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-770-8214
Mailing Address - Street 1:20313 SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23803-1637
Mailing Address - Country:US
Mailing Address - Phone:757-687-9236
Mailing Address - Fax:
Practice Address - Street 1:20313 SHEFFIELD PL
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-1637
Practice Address - Country:US
Practice Address - Phone:757-687-9236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities