Healthcare Provider Details

I. General information

NPI: 1013915537
Provider Name (Legal Business Name): QL-ROCKY MOUNTAIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 DOWNING ST
DENVER CO
80205-5234
US

IV. Provider business mailing address

2201 DOWNING ST
DENVER CO
80205-5234
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-4825
  • Fax: 303-832-4190
Mailing address:
  • Phone: 303-861-4825
  • Fax: 303-832-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0207
License Number StateCO

VIII. Authorized Official

Name: MARY KORETKE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 720-974-6278