Provider Demographics
NPI:1144549569
Name:QL LOWRY PARK, LLC
Entity type:Organization
Organization Name:QL LOWRY PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:303-238-3838
Mailing Address - Street 1:8505 E LOWRY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7029
Mailing Address - Country:US
Mailing Address - Phone:303-364-8500
Mailing Address - Fax:720-858-6620
Practice Address - Street 1:8505 E LOWRY BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7029
Practice Address - Country:US
Practice Address - Phone:303-864-8500
Practice Address - Fax:720-858-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23R463310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84700564Medicaid