MEDICARE: CHATEAU BRICKYARD OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1619657046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATEAU BRICKYARD OPERATIONS LLC

Provider Business Mailing Address
First Line	:	3080 S RICHMOND ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3000
Country	:	US
Telephone Number	:	801-206-4084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3080 S RICHMOND ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3000
Country	:	US
Telephone Number	:	801-206-4084
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ROBERT TOD MURRAY
Credential	:
Telephone Number	:	469-745-8277

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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