Healthcare Provider Details

I. General information

NPI: 1053728543
Provider Name (Legal Business Name): EHS CENTERVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 RAWLINS CIR
CENTERVILLE UT
84014-2104
US

IV. Provider business mailing address

463 RAWLINS CIR
CENTERVILLE UT
84014-2104
US

V. Phone/Fax

Practice location:
  • Phone: 801-683-6521
  • Fax:
Mailing address:
  • Phone: 801-683-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2014-ALI-82394
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number2014-ALI-82394
License Number StateUT

VIII. Authorized Official

Name: MATTHEW RASBAND
Title or Position: PRESIDENT
Credential:
Phone: 801-683-6521