Provider Demographics
NPI:1669857355
Name:BEACON HEIGHTS SENIOR LIVING LLC
Entity Type:Organization
Organization Name:BEACON HEIGHTS SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-657-2445
Mailing Address - Street 1:3784 W VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8085
Mailing Address - Country:US
Mailing Address - Phone:801-657-2445
Mailing Address - Fax:
Practice Address - Street 1:3784 W VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8085
Practice Address - Country:US
Practice Address - Phone:801-657-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2015-ALII-UT000547310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility