1Quality Life

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

32066 Issued in CO

Legal business name

1QUALITY LIFE

Doing business as

Quality Life Service L.L.C.

Practice address

11975 Reed St
Suite 1
Broomfield, CO 80020-2814

Phone

(303) 439-2122

Fax

(303) 439-2622

NPI assigned

Feb 12, 2007

Last updated

Jun 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Eugene A. Van Blaricom, BACHELOR OF SCIENCE

Title

Director Owner

Phone

(303) 439-2122

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Quality Life Service L.L.C. Doing business as

Locations

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1699816488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11975 REED STREET",
            "address_2": "SUITE 1",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202815",
            "telephone_number": "303-439-2122",
            "fax_number": "303-439-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11975 REED ST",
            "address_2": "SUITE 1",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202814",
            "telephone_number": "303-439-2122",
            "fax_number": "303-439-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1QUALITY LIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "VAN BLARICOM",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DIRECTOR  OWNER",
        "authorized_official_telephone_number": "303-439-2122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BACHELOR OF SCIENCE"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CO",
            "license": "32066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0147588",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Life Service L.L.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.