Provider Demographics
NPI:1114371564
Name:3300 SOUTH OPERATING LLC
Entity Type:Organization
Organization Name:3300 SOUTH OPERATING LLC
Other - Org Name:OSMOND SENIOR LIVING - SALT LAKE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO MGMT COMPANY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-460-1625
Mailing Address - Street 1:950 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2141
Mailing Address - Country:US
Mailing Address - Phone:801-467-0060
Mailing Address - Fax:
Practice Address - Street 1:950 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2141
Practice Address - Country:US
Practice Address - Phone:801-467-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2016-ALII-UT000740311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)