MEDICARE: HIGHLAND COVE RETIREMENT COMMUNITY

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	310400000X	Assisted Living Facility	2007-ALI-255	UT

General Provider Information

NPI Number	:	1699973461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND COVE RETIREMENT COMMUNITY

Provider Business Mailing Address
First Line	:	3750 HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3206
Country	:	US
Telephone Number	:	801-272-8226
Fax Number	:	801-272-6811

Provider Business Practice Location Address
First Line	:	3750 HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3206
Country	:	US
Telephone Number	:	801-272-8226
Fax Number	:	801-272-6811

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	STAN KETCHER
Credential	:
Telephone Number	:	801-272-8226

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	08/22/2020

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