Provider Demographics
NPI:1588994776
Name:QUALITY LIFE ASSOCIATES
Entity type:Organization
Organization Name:QUALITY LIFE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY LIFE ASSOCIATES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-571-4455
Mailing Address - Street 1:2619 N QUALITY LN
Mailing Address - Street 2:SUITE 325
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5589
Mailing Address - Country:US
Mailing Address - Phone:479-571-4455
Mailing Address - Fax:479-571-2288
Practice Address - Street 1:2619 N QUALITY LN
Practice Address - Street 2:SUITE 325
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5589
Practice Address - Country:US
Practice Address - Phone:479-571-4455
Practice Address - Fax:479-571-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188872756Medicaid