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General NPI Number Information
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NPI Number | 1124177233
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Entity Type | Organization
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Legal Business Name | JORDAN HOUSE ASSISTED LIVING, LC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1517 TEMPLE LN
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-2415
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Country | US
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Telephone | 801-254-0373
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Fax | 801-254-0250
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Provider Business Mailing Address
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Address Line | 1517 TEMPLE LN
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-2415
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Country | US
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Telephone | 801-254-0373
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Fax | 801-254-0250
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | MR. JAUNICE KAY MINOR
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Credential |
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Telephone | 801-269-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALII17895
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License Number State | UT
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