MEDICARE: QL-ROCKY MOUNTAIN, LLC

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
1	314000000X	Skilled Nursing Facility	0207	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013915537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QL-ROCKY MOUNTAIN, LLC

Provider Business Mailing Address
First Line	:	2201 DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5234
Country	:	US
Telephone Number	:	303-861-4825
Fax Number	:	303-832-4190

Provider Business Practice Location Address
First Line	:	2201 DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5234
Country	:	US
Telephone Number	:	303-861-4825
Fax Number	:	303-832-4190

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MARY KORETKE
Credential	:
Telephone Number	:	720-974-6278

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/18/2016

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