Provider Demographics
NPI: | 1790350056 |
---|---|
Name: | QUALITY LIVING HOME CARE |
Entity Type: | Organization |
Organization Name: | QUALITY LIVING HOME CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | IYONNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-384-4845 |
Mailing Address - Street 1: | 134 W DESERT LN |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85041-8121 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-384-4845 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 134 W DESERT LN |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85041-8121 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-384-4845 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-20 |
Last Update Date: | 2021-05-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |