Provider Demographics
NPI:1811145030
Name:QUALITY LIFESTYLE SERVICE INC
Entity type:Organization
Organization Name:QUALITY LIFESTYLE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:DESHAWN
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-386-5714
Mailing Address - Street 1:5102 HWY 58
Mailing Address - Street 2:STE 4
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1646
Mailing Address - Country:US
Mailing Address - Phone:423-386-5714
Mailing Address - Fax:423-386-5716
Practice Address - Street 1:5102 HWY 58
Practice Address - Street 2:SUITE 4
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1646
Practice Address - Country:US
Practice Address - Phone:423-386-5714
Practice Address - Fax:423-386-5716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALITY LIFESTYLE SERVICE INC ADULT DAY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-29
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-27A347C00000X, 343900000X
TN21T251C00000X
TNC219-058-9914320800000X
TNC219-058-9913320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445199Medicaid