Provider Demographics
NPI:1033465588
Name:BIENESTAR INC
Entity Type:Organization
Organization Name:BIENESTAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-428-9802
Mailing Address - Street 1:1777 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3925
Mailing Address - Country:US
Mailing Address - Phone:720-428-9802
Mailing Address - Fax:
Practice Address - Street 1:1777 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3925
Practice Address - Country:US
Practice Address - Phone:720-428-9802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty