Healthcare Provider Details

I. General information

NPI: 1245304948
Provider Name (Legal Business Name): QUALITY LIFE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 COURTHOUSE RD
CHESTERFIELD VA
23832-7279
US

IV. Provider business mailing address

PO BOX 5684
MIDLOTHIAN VA
23112-0029
US

V. Phone/Fax

Practice location:
  • Phone: 804-745-5000
  • Fax: 888-820-5670
Mailing address:
  • Phone: 804-307-0041
  • Fax: 888-820-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number88501001
License Number StateVA

VIII. Authorized Official

Name: ROBERT SHELTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-307-0041