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General NPI Number Information
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NPI Number | 1184877052
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Entity Type | Organization
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Legal Business Name | OUR HOUSE OF TREMONTON
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 429 N 400 W
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City | TREMONTON
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State | UT
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Zip | 84337-1222
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Country | US
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Telephone | 435-257-5658
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Fax |
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Provider Business Mailing Address
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Address Line | 362 N 300 E
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City | LOGAN
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State | UT
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Zip | 84321-4107
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Country | US
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Telephone | 435-757-0658
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GENE SPAULDING
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Credential |
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Telephone | 435-757-0658
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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 | 2008ALI78529
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License Number State | UT
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