Provider Demographics
NPI:1215177605
Name:QUALITY OF LIFE ACTIVITIES CENTER
Entity type:Organization
Organization Name:QUALITY OF LIFE ACTIVITIES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-876-4713
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-0806
Mailing Address - Country:US
Mailing Address - Phone:601-876-4713
Mailing Address - Fax:601-876-4714
Practice Address - Street 1:45 NEEDHAM JONES RD
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-7608
Practice Address - Country:US
Practice Address - Phone:601-876-4713
Practice Address - Fax:601-876-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QA0600X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services