1720134836 NPI number — BENEFICIAL LIVING SYSTEMS

Table of content: (NPI 1720134836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720134836 NPI number — BENEFICIAL LIVING SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEFICIAL LIVING SYSTEMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CASTLE ROCK CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720134836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3519 E SHEA BLVD
Provider Second Line Business Mailing Address:
SUITE 133
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85028-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-368-8203
Provider Business Mailing Address Fax Number:
602-368-8211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 HOME ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80108-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-688-3174
Provider Business Practice Location Address Fax Number:
303-688-8051
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISH
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FINANCE MANAGER
Authorized Official Telephone Number:
602-368-8203

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0395 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39526054 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79475744 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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