Provider Demographics
NPI:1215471370
Name:FAMILY CARE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:FAMILY CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:970-210-0292
Mailing Address - Street 1:207 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-3421
Mailing Address - Country:US
Mailing Address - Phone:970-210-0292
Mailing Address - Fax:970-314-9697
Practice Address - Street 1:174 EDLUN RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-2220
Practice Address - Country:US
Practice Address - Phone:970-241-6379
Practice Address - Fax:970-314-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23111U3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness