=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134548803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEE HIVE HOMES OF THE GILA VALLEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2014
-----------------------------------------------------
Last Update Date | 04/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3150 W. MAIN ST.
-----------------------------------------------------
City | THATCHER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-251-1300
-----------------------------------------------------
Fax | 928-251-1301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 609
-----------------------------------------------------
City | EAGAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85925-0609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-251-1300
-----------------------------------------------------
Fax | 928-251-1301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SPENCER HEAP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-251-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | AL9332C
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------