Provider Demographics
NPI:1073988473
Name:S-H ASHFORD OPCO LLC
Entity Type:Organization
Organization Name:S-H ASHFORD OPCO LLC
Other - Org Name:HIGHLAND GLEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-242-8377
Mailing Address - Street 1:4 PARK PLZ STE 400
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-2507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10322 N 4800 W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8965
Practice Address - Country:US
Practice Address - Phone:801-610-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility