MEDICARE: LIFE QUEST INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency	NM
3	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952425688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE QUEST INC

Provider Business Mailing Address
First Line	:	907 N POPE ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5150
Country	:	US
Telephone Number	:	505-388-1976
Fax Number	:	505-538-2339

Provider Business Practice Location Address
First Line	:	907 N POPE ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5150
Country	:	US
Telephone Number	:	505-388-1976
Fax Number	:	505-538-2339

Authorized Official
Title or Position	:	CEO
Name	:	MRS. EVANGELINE HOLGUIN ZAMORA
Credential	:
Telephone Number	:	15053881976

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/09/2007

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Directions to “LIFE QUEST INC ” Practice Location

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