=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992681688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RMCE HEIRLOOM ALF OC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 N CARBON AVE
-----------------------------------------------------
City | PRICE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84501-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-636-8441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 598 W 900 S STE 220
-----------------------------------------------------
City | WOODS CROSS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84010-8195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-397-4697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CDO
-----------------------------------------------------
Name | JASON D GATHERUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-397-4187
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------