Provider Demographics
NPI:1548578834
Name:S-H OPCO BEAR CREEK, LLC
Entity Type:Organization
Organization Name:S-H OPCO BEAR CREEK, LLC
Other - Org Name:BROOKDALE BEAR CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:OHLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:1685 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4207
Mailing Address - Country:US
Mailing Address - Phone:719-329-1774
Mailing Address - Fax:719-329-1695
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:719-329-1695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065373Medicare Oscar/Certification