{
"Npi": {
"NPI": "1245304948",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "QUALITY LIFE SERVICES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 5684",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDLOTHIAN",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23112-0029",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-307-0041",
"MailingAddressFaxNumber": "888-820-5670",
"FirstLinePracticeLocationAddress": "3610 COURTHOUSE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHESTERFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23832-7279",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-745-5000",
"PracticeLocationAddressFaxNumber": "888-820-5670",
"EnumerationDate": "11/17/2006",
"LastUpdateDate": "09/07/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHELTON",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "804-307-0041",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "320600000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
"LicenseNumber": "88501001",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}