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General NPI Number Information
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NPI Number | 1144549122
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Entity Type | Organization
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Legal Business Name | CACHE VALLEY ASSISTED LIVING
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Dates
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Enumeration Date | 05/29/2010
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Last Update Date | 05/29/2010
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Provider Practice Location Address
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Address Line | 233 N MAIN ST
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City | PROVIDENCE
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State | UT
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Zip | 84332-9622
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Country | US
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Telephone | 435-972-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 233 N MAIN ST
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City | PROVIDENCE
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State | UT
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Zip | 84332-9622
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Country | US
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Telephone | 435-972-4770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GENE SPAULDING
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Credential |
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Telephone | 435-792-4770
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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 |
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License Number State |
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