Healthcare Provider Details

I. General information

NPI: 1154508562
Provider Name (Legal Business Name): QUALITY LIVING SUPPORT,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 OLD WINTER GARDEN RD U6-1
ORLANDO FL
32805-1104
US

IV. Provider business mailing address

3231 OLD WINTER GARDEN RD U6-1
ORLANDO FL
32805-1104
US

V. Phone/Fax

Practice location:
  • Phone: 407-376-8488
  • Fax: 407-297-8335
Mailing address:
  • Phone: 407-376-8488
  • Fax: 407-297-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. WANDA KAY BAKER
Title or Position: CEO
Credential: PHD
Phone: 407-376-8488