Healthcare Provider Details

I. General information

NPI: 1306844857
Provider Name (Legal Business Name): QL-UPTOWN HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/18/2017
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: 303-860-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0631
License Number StateCO

VIII. Authorized Official

Name: MISS MARY KORETKE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 303-238-3838