Provider Demographics
NPI:1871364414
Name:QUALITY OF LIFE HOME CARE LLC
Entity type:Organization
Organization Name:QUALITY OF LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:ALAYNE
Authorized Official - Last Name:SIRULL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-799-3491
Mailing Address - Street 1:2202 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3442
Mailing Address - Country:US
Mailing Address - Phone:706-799-3491
Mailing Address - Fax:
Practice Address - Street 1:10 YATES LN
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:SC
Practice Address - Zip Code:29847-3454
Practice Address - Country:US
Practice Address - Phone:706-814-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty