Healthcare Provider Details

I. General information

NPI: 1558947531
Provider Name (Legal Business Name): QLIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 FOREST AVE STE 102
RICHMOND VA
23226-3742
US

IV. Provider business mailing address

7100 FOREST AVE STE 102
RICHMOND VA
23226-3742
US

V. Phone/Fax

Practice location:
  • Phone: 757-687-9236
  • Fax: 804-548-4141
Mailing address:
  • Phone: 757-687-9236
  • Fax: 804-548-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY JEROME BLALOCK JR.
Title or Position: CEO
Credential:
Phone: 757-770-8214