Provider Demographics
NPI:1639381841
Name:BEEHIVE HOMES OF SPANISH FORK LLC
Entity Type:Organization
Organization Name:BEEHIVE HOMES OF SPANISH FORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-465-7781
Mailing Address - Street 1:4273 W 12200 SO
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651
Mailing Address - Country:US
Mailing Address - Phone:801-465-7781
Mailing Address - Fax:801-465-1138
Practice Address - Street 1:858 E 100 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2240
Practice Address - Country:US
Practice Address - Phone:801-798-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007AL1-762310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility