Provider Demographics
NPI:1851988471
Name:BEEWELL ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BEEWELL ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/MHA
Authorized Official - Phone:801-696-7587
Mailing Address - Street 1:8007 S 6910 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3117
Mailing Address - Country:US
Mailing Address - Phone:801-696-7587
Mailing Address - Fax:
Practice Address - Street 1:816 W KIOWA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1423
Practice Address - Country:US
Practice Address - Phone:719-578-1355
Practice Address - Fax:719-578-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO230508OtherSTATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT