Provider Demographics
NPI:1093927352
Name:QUALITY HOME LIVING
Entity Type:Organization
Organization Name:QUALITY HOME LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-216-9353
Mailing Address - Street 1:5900 BLANCA CT
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1023
Mailing Address - Country:US
Mailing Address - Phone:303-216-9353
Mailing Address - Fax:303-216-9354
Practice Address - Street 1:5900 BLANCA CT
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1023
Practice Address - Country:US
Practice Address - Phone:303-216-9353
Practice Address - Fax:303-216-9354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3B-0945171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37620584Medicaid