Provider Demographics
NPI:1942537428
Name:LIFEQUEST DISABILITIES SERVICES, INC
Entity Type:Organization
Organization Name:LIFEQUEST DISABILITIES SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA/QP
Authorized Official - Phone:910-389-0901
Mailing Address - Street 1:325 BANNERMANS MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8105
Mailing Address - Country:US
Mailing Address - Phone:910-389-0901
Mailing Address - Fax:910-430-4310
Practice Address - Street 1:231 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4736
Practice Address - Country:US
Practice Address - Phone:910-430-4152
Practice Address - Fax:910-430-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418747Medicaid