Healthcare Provider Details

I. General information

NPI: 1740548205
Provider Name (Legal Business Name): STONEHENGE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 W 800 S
MAPLETON UT
84664-4402
US

IV. Provider business mailing address

791 W 800 S
MAPLETON UT
84664-4402
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-7625
  • Fax: 801-489-6730
Mailing address:
  • Phone: 801-358-7625
  • Fax: 801-489-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CORY ROBERT ROBISON
Title or Position: MANAGER
Credential:
Phone: 801-358-7625