Provider Demographics
NPI:1083899199
Name:RIVER MEADOWS SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:RIVER MEADOWS SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-692-2100
Mailing Address - Street 1:137 RED PINE DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-5611
Mailing Address - Country:US
Mailing Address - Phone:801-692-2100
Mailing Address - Fax:801-692-2111
Practice Address - Street 1:137 RED PINE DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-5611
Practice Address - Country:US
Practice Address - Phone:801-692-2100
Practice Address - Fax:801-692-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility