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General NPI Number Information
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NPI Number | 1194992354
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Entity Type | Organization
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Legal Business Name | HEIRLOOM INN, INC.
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 145 N CARBON AVE
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City | PRICE
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State | UT
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Zip | 84501-2464
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Country | US
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Telephone | 435-636-8441
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Fax | 435-613-8040
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Provider Business Mailing Address
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Address Line | 145 N CARBON AVE
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City | PRICE
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State | UT
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Zip | 84501-2464
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Country | US
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Telephone | 435-636-8441
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Fax | 435-613-8040
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Authorized Official
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Title or Position | ADMINISTRATION (FINANCE)
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Name | MR. ERROL D. DURRANT
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Credential |
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Telephone | 435-636-8441
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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 | 2006-ALII-16260
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License Number State | UT
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