Healthcare Provider Details

I. General information

NPI: 1972621456
Provider Name (Legal Business Name): ST GEORGE SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W 2025 SOUTH CIRCLE
SAINT GEORGE UT
84770-8741
US

IV. Provider business mailing address

PO BOX 3006
SALEM OR
97302-0006
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-1117
  • Fax: 503-485-1279
Mailing address:
  • Phone: 503-375-9076
  • Fax: 503-485-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JON M HARDER
Title or Position: MANAGER
Credential:
Phone: 503-375-9016