Quality Life Providers LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209002055 Issued in IL

Legal business name

QUALITY LIFE PROVIDERS LLC

Practice address

4166 Blanchan Ave
Brookfield, IL 60513-1802

Phone

(847) 980-6325

Fax

(708) 387-2348

NPI assigned

Nov 5, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Paul Harper, LNHA, MBA

Title

Chief Administrator

Phone

(847) 980-6325

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Quality Life Providers, LLC Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Colleen Ann Mikula, NP

  • Adult Health Nurse Practitioner
  • Warren, MI
  • NPI 1518081686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1538460670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4166 BLANCHAN AVE",
            "city": "BROOKFIELD",
            "state": "IL",
            "postal_code": "605131802",
            "telephone_number": "847-980-6325",
            "fax_number": "708-387-2348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4166 BLANCHAN AVE",
            "city": "BROOKFIELD",
            "state": "IL",
            "postal_code": "605131802",
            "telephone_number": "847-980-6325",
            "fax_number": "708-387-2348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY LIFE PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-05",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATOR",
        "authorized_official_telephone_number": "847-980-6325",
        "authorized_official_credential": "LNHA, MBA"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209002055",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209002055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P52930",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Life Providers, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Lina Poskocimas, M.S. CCC-SLP
• Naomi Rose Preedin
• Corinne Marie Puchalla, PHARMD
• Allison N Ramsey, FNP
• William G Ressl, MDIV, MSW, PHD, LCSW
• Diana Rivera, LCSW
• Angie Runyan, M.A., IBCLC
• Elise Salo, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Brookfield, IL
• Providers in Brookfield, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.