Healthcare Provider Details

I. General information

NPI: 1366575482
Provider Name (Legal Business Name): MOUNTAIN RIDGE ASSISTED LIIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 SKYLINE DR
SOUTH OGDEN UT
84403-5362
US

IV. Provider business mailing address

1885 SKYLINE DR
SOUTH OGDEN UT
84403-5362
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5111
  • Fax: 801-475-1884
Mailing address:
  • Phone: 801-475-5111
  • Fax: 801-475-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateUT

VIII. Authorized Official

Name: ANDREA THORPE
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 801-475-5111