Provider Demographics
NPI:1033391636
Name:HOBBLECREEK HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOBBLECREEK HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:801-400-1103
Mailing Address - Street 1:1761 COBBLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3236
Mailing Address - Country:US
Mailing Address - Phone:801-400-1103
Mailing Address - Fax:
Practice Address - Street 1:1761 COBBLESTONE RD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-3236
Practice Address - Country:US
Practice Address - Phone:801-400-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320175-4405310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility