Healthcare Provider Details

I. General information

NPI: 1093422370
Provider Name (Legal Business Name): CASCADES AT DESERT VIEW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SPRAGUE AVE
BUHL ID
83316-1827
US

IV. Provider business mailing address

5314 N RIVER RUN DR STE 140
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 208-543-6401
  • Fax:
Mailing address:
  • Phone: 801-426-4905
  • Fax: 801-426-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DARIN MCSPADDEN
Title or Position: MANAGER
Credential:
Phone: 801-426-4905