Provider Demographics
NPI:1083852057
Name:SHANEKOR LLC
Entity Type:Organization
Organization Name:SHANEKOR LLC
Other - Org Name:CANYON COVE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-783-6499
Mailing Address - Street 1:1027 E 800 N
Mailing Address - Street 2:1045 E. 800 N.
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4313
Mailing Address - Country:US
Mailing Address - Phone:801-783-6499
Mailing Address - Fax:
Practice Address - Street 1:1027 E 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4313
Practice Address - Country:US
Practice Address - Phone:801-783-6499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2008-ALI-76697261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care