Healthcare Provider Details

I. General information

NPI: 1023574183
Provider Name (Legal Business Name): QUALITY LIVES ASSISTED LIVING /ADULT DAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 PAULINE ST
GREENVILLE MS
38701-7012
US

IV. Provider business mailing address

226 PAULINE ST
GREENVILLE MS
38701-7012
US

V. Phone/Fax

Practice location:
  • Phone: 662-822-5784
  • Fax: 662-702-5178
Mailing address:
  • Phone: 662-822-5784
  • Fax: 662-702-5178

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: MRS. GYTON BRIJJETTA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 662-822-5784