Provider Demographics
NPI:1750034708
Name:CHANCELLOR HEALTH CARE OF COLORADO, LLC
Entity Type:Organization
Organization Name:CHANCELLOR HEALTH CARE OF COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLUNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-291-3582
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:970-522-4892
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:970-522-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility