Provider Demographics
NPI:1023003167
Name:CHANCELLOR HEALTH CARE OF COLORADO, LLC
Entity Type:Organization
Organization Name:CHANCELLOR HEALTH CARE OF COLORADO, LLC
Other - Org Name:DEVONSHIRE ACRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:970-522-4888
Mailing Address - Street 1:1330 SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-2241
Mailing Address - Country:US
Mailing Address - Phone:970-522-4888
Mailing Address - Fax:
Practice Address - Street 1:1330 SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2241
Practice Address - Country:US
Practice Address - Phone:970-522-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04181962310400000X
CO05652250313M00000X, 314000000X
CO065150314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04181962Medicaid
CO05652250Medicaid
CO04181962Medicaid