Provider Demographics
NPI:1992826051
Name:LIFE QUEST, INC
Entity Type:Organization
Organization Name:LIFE QUEST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-388-1976
Mailing Address - Street 1:907 N POPE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5150
Mailing Address - Country:US
Mailing Address - Phone:505-388-1976
Mailing Address - Fax:505-538-2339
Practice Address - Street 1:907 N POPE ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5150
Practice Address - Country:US
Practice Address - Phone:505-388-1976
Practice Address - Fax:505-538-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D1036Medicaid