Provider Demographics
NPI:1366896730
Name:GOQ
Entity type:Organization
Organization Name:GOQ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-421-3600
Mailing Address - Street 1:1127 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1506
Mailing Address - Country:US
Mailing Address - Phone:303-421-3600
Mailing Address - Fax:303-388-1712
Practice Address - Street 1:6447 QUAIL ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-2600
Practice Address - Country:US
Practice Address - Phone:303-456-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02A839314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065406Medicare PIN