=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700522240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COTTONWOOD HEIGHTS SENIOR LIVING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2022
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8325 S HIGHLAND DR
-----------------------------------------------------
City | COTTONWOOD HEIGHTS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84093-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-383-2445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12377 MERIT DR STE 500
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT CONTROLLER
-----------------------------------------------------
Name | AMBER ASHFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-443-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------