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General NPI Number Information
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NPI Number | 1023003167
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Entity Type | Organization
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Legal Business Name | CHANCELLOR HEALTH CARE OF COLORADO, LLC
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 1330 SIDNEY AVE
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City | STERLING
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State | CO
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Zip | 80751-2241
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Country | US
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Telephone | 970-522-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 SIDNEY AVE
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City | STERLING
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State | CO
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Zip | 80751-2241
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Country | US
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Telephone | 970-522-4888
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GLORIA J KAISER
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Credential | NHA
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Telephone | 970-522-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 05652250
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 05652250
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 04181962
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 065150
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License Number State | CO
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