Provider Demographics
NPI:1124326905
Name:SDSB LLC
Entity type:Organization
Organization Name:SDSB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DAFFENY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-554-1115
Mailing Address - Street 1:30799 COUNTY ROAD 46
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:CO
Mailing Address - Zip Code:80720-9506
Mailing Address - Country:US
Mailing Address - Phone:970-554-1115
Mailing Address - Fax:
Practice Address - Street 1:30799 COUNTY ROAD 46
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:CO
Practice Address - Zip Code:80720-9506
Practice Address - Country:US
Practice Address - Phone:970-554-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230186310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO230186OtherSTATE LICENSE NUMBER FOR ASSISTED LIVING