Provider Demographics
NPI:1629602933
Name:MQ LONG TERM CARE AGENCY
Entity Type:Organization
Organization Name:MQ LONG TERM CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-933-5099
Mailing Address - Street 1:1700 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5256
Mailing Address - Country:US
Mailing Address - Phone:303-238-1488
Mailing Address - Fax:303-238-1459
Practice Address - Street 1:1700 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5256
Practice Address - Country:US
Practice Address - Phone:303-238-1488
Practice Address - Fax:303-238-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care