Provider Demographics
NPI:1114542198
Name:ANTIOCH DUNES HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ANTIOCH DUNES HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:140 N UNION AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2956
Mailing Address - Country:US
Mailing Address - Phone:801-447-9829
Mailing Address - Fax:
Practice Address - Street 1:1210 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2327
Practice Address - Country:US
Practice Address - Phone:925-757-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility