Healthcare Provider Details

I. General information

NPI: 1922211366
Provider Name (Legal Business Name): BEE HIVE - FORT LUPTON #2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 4TH ST
FORT LUPTON CO
80621-1738
US

IV. Provider business mailing address

1331 8TH AVE
GREELEY CO
80631-4601
US

V. Phone/Fax

Practice location:
  • Phone: 303-857-0116
  • Fax: 303-857-0117
Mailing address:
  • Phone: 970-506-0006
  • Fax: 970-378-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-0054
License Number StateCO

VIII. Authorized Official

Name: MR. JERRY L. CHRISTIAN
Title or Position: PRESIDENT
Credential:
Phone: 970-506-0006