Healthcare Provider Details

I. General information

NPI: 1275992794
Provider Name (Legal Business Name): QL-UPTOWN HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 E 18TH AVE
DENVER CO
80203-1414
US

IV. Provider business mailing address

745 E 18TH AVE
DENVER CO
80203-1414
US

V. Phone/Fax

Practice location:
  • Phone: 303-860-0500
  • Fax: 303-860-0037
Mailing address:
  • Phone: 303-860-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020452
License Number StateCO

VIII. Authorized Official

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