Healthcare Provider Details

I. General information

NPI: 1861665200
Provider Name (Legal Business Name): HUENEME HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E 1400 S
OREM UT
84097-7707
US

IV. Provider business mailing address

575 E 1400 S
OREM UT
84097-7707
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-4741
  • Fax: 801-226-8197
Mailing address:
  • Phone: 801-225-4741
  • Fax: 801-226-8197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. SOON BURNAM
Title or Position: TREASURER OF MANAGEMENT COMPANY
Credential:
Phone: 949-540-1249