Healthcare Provider Details

I. General information

NPI: 1912614314
Provider Name (Legal Business Name): BENT COUNTY MEMORIAL NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 3RD ST
LAS ANIMAS CO
81054-1002
US

IV. Provider business mailing address

3440 YOUNGFIELD ST
WHEAT RIDGE CO
80033-5245
US

V. Phone/Fax

Practice location:
  • Phone: 719-456-1340
  • Fax: 719-456-3131
Mailing address:
  • Phone: 720-929-0086
  • Fax: 720-929-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LINDA BRONNENBERG
Title or Position: LEAD BILLER
Credential:
Phone: 720-929-0086