Provider Demographics
NPI:1386455020
Name:STONEBRIDGE SENIOR LLC
Entity type:Organization
Organization Name:STONEBRIDGE SENIOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLYMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-667-6217
Mailing Address - Street 1:11825 W 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4307
Mailing Address - Country:US
Mailing Address - Phone:303-667-6217
Mailing Address - Fax:
Practice Address - Street 1:11825 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4307
Practice Address - Country:US
Practice Address - Phone:303-667-6217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility