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General NPI Number Information
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NPI Number | 1447868179
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Entity Type | Organization
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Legal Business Name | QUALITY OF LIFE CARE, LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 4 GIGANTE PL
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-1205
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Country | US
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Telephone | 201-394-2397
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Fax |
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Provider Business Mailing Address
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Address Line | 4 GIGANTE PL
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-1205
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Country | US
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Telephone | 201-394-2397
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING/BILLING MANAGER
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Name | TERESA SHOKRY
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Credential |
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Telephone | 267-632-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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