Provider Demographics
NPI:1265840391
Name:S-H OPCO CLIFF VIEW, LLC
Entity Type:Organization
Organization Name:S-H OPCO CLIFF VIEW, LLC
Other - Org Name:SOUTHGATE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-639-0446
Mailing Address - Street 1:134 W 2025 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-1117
Mailing Address - Fax:801-214-1970
Practice Address - Street 1:134 W 2025 S
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-8790
Practice Address - Country:US
Practice Address - Phone:435-628-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility