Provider Demographics
NPI:1447868179
Name:QUALITY OF LIFE CARE, LLC
Entity type:Organization
Organization Name:QUALITY OF LIFE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-632-2804
Mailing Address - Street 1:4 GIGANTE PL
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1205
Mailing Address - Country:US
Mailing Address - Phone:201-394-2397
Mailing Address - Fax:
Practice Address - Street 1:4 GIGANTE PL
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1205
Practice Address - Country:US
Practice Address - Phone:201-394-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty