Provider Demographics
NPI:1164876041
Name:GRIZZLY PEAK ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:GRIZZLY PEAK ASSISTED LIVING, LLC
Other - Org Name:BEEHIVE HOMES OF PERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-893-2503
Mailing Address - Street 1:126 W 1550 S
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 W 1550 S
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-4277
Practice Address - Country:US
Practice Address - Phone:435-732-1724
Practice Address - Fax:435-723-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)