Healthcare Provider Details

I. General information

NPI: 1760818264
Provider Name (Legal Business Name): CANYON BREEZE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E 240 N
OREM UT
84057-4889
US

IV. Provider business mailing address

380 E 240 N
OREM UT
84057-4889
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-8338
  • Fax: 801-235-0877
Mailing address:
  • Phone: 801-226-8338
  • Fax: 801-235-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2013-PCA-UT000607
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: PAUL R SORENSON
Title or Position: OWNER
Credential:
Phone: 801-372-1613