1063506848 NPI number — BEE HIVE SKILLED CARE HOME, LLC

Table of content: (NPI 1063506848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063506848 NPI number — BEE HIVE SKILLED CARE HOME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEE HIVE SKILLED CARE HOME, LLC
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:
Provider Other Organization Name Type Code:
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:
1063506848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1304 REDWOOD RD
Provider Second Line Business Mailing Address:
106
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84045-4734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-223-4344
Provider Business Mailing Address Fax Number:
801-223-4348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 W 500 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84057-3880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-223-4344
Provider Business Practice Location Address Fax Number:
801-223-4348
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
801-376-6185

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2006-SHCF-47328 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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