Provider Demographics
NPI:1376699496
Name:BENEFICIAL LIVING SYSTEMS
Entity Type:Organization
Organization Name:BENEFICIAL LIVING SYSTEMS
Other - Org Name:GARDEN OF THE GODS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-368-8203
Mailing Address - Street 1:3519 E SHEA BLVD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3358
Mailing Address - Country:US
Mailing Address - Phone:602-368-8203
Mailing Address - Fax:602-368-8211
Practice Address - Street 1:104 LOIS LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1320
Practice Address - Country:US
Practice Address - Phone:719-635-2569
Practice Address - Fax:719-635-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0375314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95258736Medicaid
CO50709348Medicaid
CO95258736Medicaid