Provider Demographics
NPI:1235268202
Name:SUPERIOR ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SUPERIOR ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORANT
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:BODO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-495-1086
Mailing Address - Street 1:2499 CHARROS RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4815
Mailing Address - Country:US
Mailing Address - Phone:801-495-1086
Mailing Address - Fax:
Practice Address - Street 1:2499 CHARROS RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4815
Practice Address - Country:US
Practice Address - Phone:801-495-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-AL1-72909310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility