MEDICARE: BEE HIVE - FT. LUPTON #3, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	AL-0338	CO

General Provider Information

NPI Number	:	1164635504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEE HIVE - FT. LUPTON #3, LLC

Provider Business Mailing Address
First Line	:	1331 8TH AVE
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631-4601
Country	:	US
Telephone Number	:	970-506-0006
Fax Number	:	970-378-0329

Provider Business Practice Location Address
First Line	:	1102 4TH ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1738
Country	:	US
Telephone Number	:	303-857-1921
Fax Number	:	303-857-1951

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JERRY L. CHRISTIAN
Credential	:
Telephone Number	:	970-506-0006

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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