Healthcare Provider Details

I. General information

NPI: 1659729911
Provider Name (Legal Business Name): QUALITY OF LIFE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8439 CALIFORNIA AVE
SOUTH GATE CA
90280-2413
US

IV. Provider business mailing address

8439 CALIFORNIA AVE
SOUTHGATE CA
90280-2413
US

V. Phone/Fax

Practice location:
  • Phone: 909-562-6743
  • Fax:
Mailing address:
  • Phone: 909-562-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number198601740
License Number StateCA

VIII. Authorized Official

Name: NNAEMEKA EZENAGU
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-562-6743