Healthcare Provider Details

I. General information

NPI: 1699176859
Provider Name (Legal Business Name): QUALITY CARE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N ORANGE ST
MOUNT DORA FL
32757-3013
US

IV. Provider business mailing address

1805 N ORANGE ST
MOUNT DORA FL
32757-3013
US

V. Phone/Fax

Practice location:
  • Phone: 352-735-1904
  • Fax: 352-735-1904
Mailing address:
  • Phone: 352-735-1904
  • Fax: 952-735-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. STEPHANIE RAE CUMMINGS
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 352-735-1904