Provider Demographics
NPI:1245895747
Name:HIGH DESERT ASSISTED LIVING-HOUSE 2 LLC
Entity type:Organization
Organization Name:HIGH DESERT ASSISTED LIVING-HOUSE 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-617-5888
Mailing Address - Street 1:3291 LOMBARDY LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7717
Mailing Address - Country:US
Mailing Address - Phone:970-640-7371
Mailing Address - Fax:970-644-5151
Practice Address - Street 1:3291 LOMBARDY LN
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7717
Practice Address - Country:US
Practice Address - Phone:205-617-5888
Practice Address - Fax:970-787-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness