Provider Demographics
NPI:1164978284
Name:CLC DAYSPRING VILLA, LLC
Entity Type:Organization
Organization Name:CLC DAYSPRING VILLA, LLC
Other - Org Name:DAYSPRING VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:720-974-3504
Mailing Address - Street 1:7000 E BELLEVIEW AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1660
Mailing Address - Country:US
Mailing Address - Phone:720-974-3504
Mailing Address - Fax:
Practice Address - Street 1:3777 W 26TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4003
Practice Address - Country:US
Practice Address - Phone:303-455-5066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304IX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility