Provider Demographics
NPI:1750587077
Name:SAM LEM HEAN
Entity type:Organization
Organization Name:SAM LEM HEAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:LEM
Authorized Official - Last Name:HEAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:970-210-0292
Mailing Address - Street 1:476 GUNNISON WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503
Mailing Address - Country:US
Mailing Address - Phone:970-241-6379
Mailing Address - Fax:970-523-8066
Practice Address - Street 1:174 EDLUM ROAD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503
Practice Address - Country:US
Practice Address - Phone:970-210-0292
Practice Address - Fax:970-523-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-24
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68350872Medicaid