Provider Demographics
NPI:1356669709
Name:HEARTHSTONE MANOR, INC
Entity Type:Organization
Organization Name:HEARTHSTONE MANOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:801-798-1500
Mailing Address - Street 1:1424 S 1700 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-9007
Mailing Address - Country:US
Mailing Address - Phone:801-798-1500
Mailing Address - Fax:801-798-7900
Practice Address - Street 1:1424 S 1700 E
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-9007
Practice Address - Country:US
Practice Address - Phone:801-798-1500
Practice Address - Fax:801-798-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2008-ALII-15797310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility