Provider Demographics
NPI:1659729911
Name:QUALITY OF LIFE ACADEMY
Entity Type:Organization
Organization Name:QUALITY OF LIFE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NNAEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZENAGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-562-6743
Mailing Address - Street 1:8439 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2413
Mailing Address - Country:US
Mailing Address - Phone:909-562-6743
Mailing Address - Fax:
Practice Address - Street 1:8439 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2413
Practice Address - Country:US
Practice Address - Phone:909-562-6743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QOL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198601740261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care