Provider Demographics
NPI:1811496300
Name:QUALIFE, LLC
Entity type:Organization
Organization Name:QUALIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDILAS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:716-982-9096
Mailing Address - Street 1:15225 SWEET CADDIES DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3208
Mailing Address - Country:US
Mailing Address - Phone:716-982-9096
Mailing Address - Fax:
Practice Address - Street 1:15225 SWEET CADDIES DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3208
Practice Address - Country:US
Practice Address - Phone:716-982-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11622756103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty