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General NPI Number Information
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NPI Number | 1942537428
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Entity Type | Organization
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Legal Business Name | LIFEQUEST DISABILITIES SERVICES, INC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 231 NEW BRIDGE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4736
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Country | US
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Telephone | 910-430-4152
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Fax | 910-430-4310
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Provider Business Mailing Address
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Address Line | 325 BANNERMANS MILL RD
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City | RICHLANDS
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State | NC
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Zip | 28574-8105
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Country | US
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Telephone | 910-389-0901
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Fax | 910-430-4310
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANE B WILLIAMS
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Credential | BA/QP
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Telephone | 910-389-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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