Provider Demographics
NPI:1841709011
Name:CD-CLS GRAND JUNCTION LLC
Entity type:Organization
Organization Name:CD-CLS GRAND JUNCTION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-974-3508
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:720-974-3508
Mailing Address - Fax:
Practice Address - Street 1:628 26 1/2 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1932
Practice Address - Country:US
Practice Address - Phone:720-560-7318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility