Provider Demographics
NPI:1912614314
Name:BENT COUNTY MEMORIAL NURSING HOME
Entity Type:Organization
Organization Name:BENT COUNTY MEMORIAL NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-929-0086
Mailing Address - Street 1:3440 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5245
Mailing Address - Country:US
Mailing Address - Phone:720-929-0086
Mailing Address - Fax:720-929-0381
Practice Address - Street 1:810 3RD ST
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1002
Practice Address - Country:US
Practice Address - Phone:719-456-1340
Practice Address - Fax:719-456-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55233538Medicaid