1326456443 NPI number — S-H OPCO BEAR CREEK, LLC

Table of content: (NPI 1326456443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326456443 NPI number — S-H OPCO BEAR CREEK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S-H OPCO BEAR CREEK, 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:
6
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:
1326456443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4525 S WASATCH BLVD, STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-495-7000
Provider Business Mailing Address Fax Number:
802-121-4970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1685 S 21ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80904-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-329-1774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BENTON
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED SIGNER
Authorized Official Telephone Number:
801-639-0446

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com