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NPI Code Detail

MEDICARE: MQ LONG TERM CARE AGENCY

MEDICARE: MQ LONG TERM 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1629602933
Entity Type Code : Organization
Provider Name (Legal Business Name) : MQ LONG TERM CARE AGENCY
Provider Business Mailing Address
First Line : 1700 WADSWORTH BLVD
Second Line :
City : LAKEWOOD
State : CO
Zip : 80214-5256
Country : US
Telephone Number : 303-238-1488
Fax Number : 303-238-1459
Provider Business Practice Location Address
First Line : 1700 WADSWORTH BLVD
Second Line :
City : LAKEWOOD
State : CO
Zip : 80214-5256
Country : US
Telephone Number : 303-238-1488
Fax Number : 303-238-1459
Authorized Official
Title or Position : MANAGER
Name : MRS. AMANDA PHAN
Credential :
Telephone Number : 720-933-5099
Provider Enumeration Date : 02/25/2020
Last Update Date : 02/25/2020

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Directions to “MQ LONG TERM CARE AGENCY ” Practice Location

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