Provider Demographics
NPI:1013159995
Name:ELDER ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ELDER ASSISTED LIVING LLC
Other - Org Name:BEEHIVE HOMES OF SALEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDEN/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-374-2157
Mailing Address - Street 1:1365 W 1320 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-374-2157
Mailing Address - Fax:801-932-4600
Practice Address - Street 1:1015 S 550 W
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653
Practice Address - Country:US
Practice Address - Phone:801-423-3205
Practice Address - Fax:801-932-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7294378-0160310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility