Provider Demographics
NPI:1134318546
Name:WILLOW SPRINGS ESTATES
Entity Type:Organization
Organization Name:WILLOW SPRINGS ESTATES
Other - Org Name:BEEHIVE OF PRICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-340-1160
Mailing Address - Street 1:1025 W. 470 N.
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-636-4483
Mailing Address - Fax:435-613-0423
Practice Address - Street 1:1025 W. 470 N.
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-636-4483
Practice Address - Fax:435-613-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility