Provider Demographics
NPI:1013648575
Name:SPRING GARDENS MIDVALE OPCO LLC
Entity Type:Organization
Organization Name:SPRING GARDENS MIDVALE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-244-9173
Mailing Address - Street 1:6968 S 700 W
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4546
Mailing Address - Country:US
Mailing Address - Phone:385-722-9700
Mailing Address - Fax:
Practice Address - Street 1:6968 S 700 W
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4546
Practice Address - Country:US
Practice Address - Phone:385-722-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility