Provider Demographics
NPI:1376983312
Name:MOUNTAIN VIEW RETIREMENT, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW RETIREMENT, INC.
Other - Org Name:LAKE RIDGE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:960 S GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5847
Mailing Address - Country:US
Mailing Address - Phone:801-225-6559
Mailing Address - Fax:801-225-0372
Practice Address - Street 1:960 S GENEVA RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5847
Practice Address - Country:US
Practice Address - Phone:801-225-6559
Practice Address - Fax:801-225-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013-ALI-UT207208310400000X
UT2013-ALII-UT207236310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility