Healthcare Provider Details

I. General information

NPI: 1881031920
Provider Name (Legal Business Name): BROPH'S PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DEER VALLEY DRIVE
PARK CITY UT
84060-6926
US

IV. Provider business mailing address

2563 MONITOR DR
PARK CITY UT
84060-6926
US

V. Phone/Fax

Practice location:
  • Phone: 435-640-0501
  • Fax:
Mailing address:
  • Phone: 435-640-0501
  • Fax: 435-214-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: EILEEN B KINTNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-640-0501