Basic Information
| Provider Information | |||||||||
| NPI: | 1427175306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY OF LIFE HOME HEALTH SERVICES OF HILLSBOROUGH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7235 BRYAN DAIRY RD | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275469692 | ||||||||
| FaxNumber: | 7275470942 | ||||||||
| Practice Location | |||||||||
| Address1: | 2919 SWANN AVE | ||||||||
| Address2: | SUITE 400C | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138728103 | ||||||||
| FaxNumber: | 7275470942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEENAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7275469692 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 299991075 | FL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | E9183 | 01 | FL | CLIA PROVIDER NUMBER | OTHER | 650915100 | 05 | FL | MEDICAID |