| NPI | 1770905721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDON L JOHANSEN Administrator 435-414-4646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: UT 2014-AL1-UT000G2G) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2014-01-10 |