Healthcare Provider Details

I. General information

NPI: 1043403256
Provider Name (Legal Business Name): CHESTOR HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 BOSTON AVE SUITE 100
LONGMONT CO
80501-8021
US

IV. Provider business mailing address

1831 BOSTON AVE SUITE 100
LONGMONT CO
80501-8021
US

V. Phone/Fax

Practice location:
  • Phone: 303-926-8840
  • Fax:
Mailing address:
  • Phone: 303-926-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE SPENCER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-926-8840