Provider Demographics
NPI:1578800579
Name:QUALITY LIFE HEALTH CARE LLC
Entity Type:Organization
Organization Name:QUALITY LIFE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAVORGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-562-0656
Mailing Address - Street 1:46 PRINCE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513
Mailing Address - Country:US
Mailing Address - Phone:203-562-0656
Mailing Address - Fax:203-562-0657
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-562-0656
Practice Address - Fax:203-562-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001202111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty