Healthcare Provider Details

I. General information

NPI: 1790276269
Provider Name (Legal Business Name): QUALITY LIFE LAWRENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GLENN ST
LAWRENCE MA
01843-1022
US

IV. Provider business mailing address

167 DWIGHT ROAD SUITE #207
LONGMEADOW MA
01106
US

V. Phone/Fax

Practice location:
  • Phone: 413-206-5880
  • Fax: 413-301-7994
Mailing address:
  • Phone: 413-206-5880
  • Fax: 413-301-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANDREW FELDMAN
Title or Position: OWNER
Credential:
Phone: 617-584-0258