Provider Demographics
NPI:1326456443
Name:S-H OPCO BEAR CREEK, LLC
Entity Type:Organization
Organization Name:S-H OPCO BEAR CREEK, LLC
Other - Org Name:BEAR CREEK SENIOR LIVING SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-639-0446
Mailing Address - Street 1:4525 S WASATCH BLVD, STE 300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-495-7000
Mailing Address - Fax:802-121-4970
Practice Address - Street 1:1685 S 21ST ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-5123
Practice Address - Country:US
Practice Address - Phone:719-329-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
065373Medicare Oscar/Certification