MEDICARE: QUALITY OF LIFE HOME HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1093041071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY OF LIFE HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	1609 BLUE SPRING RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5748
Country	:	US
Telephone Number	:	910-480-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 BLUE SPRING RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5748
Country	:	US
Telephone Number	:	910-480-8391
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LILA LASHELLE BROWN
Credential	:
Telephone Number	:	910-480-8391

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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