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General NPI Number Information
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NPI Number | 1154508562
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Entity Type | Organization
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Legal Business Name | QUALITY LIVING SUPPORT,INC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 3231 OLD WINTER GARDEN RD U6-1
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City | ORLANDO
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State | FL
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Zip | 32805-1104
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Country | US
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Telephone | 407-376-8488
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Fax | 407-297-8335
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Provider Business Mailing Address
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Address Line | 3231 OLD WINTER GARDEN RD U6-1
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City | ORLANDO
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State | FL
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Zip | 32805-1104
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Country | US
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Telephone | 407-376-8488
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Fax | 407-297-8335
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Authorized Official
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Title or Position | CEO
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Name | DR. WANDA KAY BAKER
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Credential | PHD
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Telephone | 407-376-8488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | FL
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