Provider Demographics
NPI:1447685821
Name:QUALITY OF LIFE HEALTH
Entity type:Organization
Organization Name:QUALITY OF LIFE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AKILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-697-0767
Mailing Address - Street 1:3109 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1256
Mailing Address - Country:US
Mailing Address - Phone:919-697-0767
Mailing Address - Fax:202-315-5833
Practice Address - Street 1:3109 PARKWAY
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1256
Practice Address - Country:US
Practice Address - Phone:919-697-0767
Practice Address - Fax:202-315-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health