Provider Demographics
| NPI: | 1790350056 |
|---|---|
| Name: | QUALITY LIVING HOME CARE |
| Entity type: | Organization |
| Organization Name: | QUALITY LIVING HOME CARE |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | IYONNA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | SMITH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 602-384-4845 |
| Mailing Address - Street 1: | 134 W DESERT LN |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85041-8121 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-384-4845 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 134 W DESERT LN |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85041-8121 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-384-4845 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-05-20 |
| Last Update Date: | 2021-05-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
| No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
