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General NPI Number Information
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NPI Number | 1659729911
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Entity Type | Organization
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Legal Business Name | QUALITY OF LIFE ACADEMY
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 8439 CALIFORNIA AVE
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City | SOUTH GATE
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State | CA
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Zip | 90280-2413
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Country | US
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Telephone | 909-562-6743
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Fax |
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Provider Business Mailing Address
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Address Line | 8439 CALIFORNIA AVE
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City | SOUTHGATE
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State | CA
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Zip | 90280-2413
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Country | US
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Telephone | 909-562-6743
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NNAEMEKA EZENAGU
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Credential |
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Telephone | 909-562-6743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 198601740
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License Number State | CA
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