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General NPI Number Information
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NPI Number | 1396235339
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Entity Type | Organization
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Legal Business Name | HHALMID
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 6968 S 700 E
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City | MIDVALE
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State | UT
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Zip | 84047
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Country | US
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Telephone | 801-910-9821
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Fax |
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Provider Business Mailing Address
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Address Line | 6968 S 700 E
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City | MIDVALE
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State | UT
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Zip | 84047
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Country | US
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Telephone | 801-910-9821
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CARLI PARDOE
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Credential |
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Telephone | 801-910-9821
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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 | UT
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