Provider Demographics
NPI:1699816488
Name:1QUALITY LIFE
Entity Type:Organization
Organization Name:1QUALITY LIFE
Other - Org Name:QUALITY LIFE SERVICE L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN BLARICOM
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR OF SCIENCE
Authorized Official - Phone:303-439-2122
Mailing Address - Street 1:11975 REED STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2815
Mailing Address - Country:US
Mailing Address - Phone:303-439-2122
Mailing Address - Fax:303-439-2622
Practice Address - Street 1:11975 REED ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2814
Practice Address - Country:US
Practice Address - Phone:303-439-2122
Practice Address - Fax:303-439-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32066320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0147588Medicaid