MEDICARE: QUALITY LIFE HOME CARE AGENCY

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235775479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY LIFE HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	240 N LEO RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-6833
Country	:	US
Telephone Number	:	843-803-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 N LEO RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-6833
Country	:	US
Telephone Number	:	843-803-8160
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. TERESA PRESSLEY
Credential	:
Telephone Number	:	843-598-3768

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	11/22/2019

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