Healthcare Provider Details

I. General information

NPI: 1023003167
Provider Name (Legal Business Name): CHANCELLOR HEALTH CARE OF COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SIDNEY AVE
STERLING CO
80751-2241
US

IV. Provider business mailing address

1330 SIDNEY AVE
STERLING CO
80751-2241
US

V. Phone/Fax

Practice location:
  • Phone: 970-522-4888
  • Fax:
Mailing address:
  • Phone: 970-522-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05652250
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number05652250
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number04181962
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number065150
License Number StateCO

VIII. Authorized Official

Name: MRS. GLORIA J KAISER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 970-522-4888