Provider Demographics
NPI:1417011669
Name:SMC EAST MILL CREEK, LLC
Entity Type:Organization
Organization Name:SMC EAST MILL CREEK, LLC
Other - Org Name:WENTWORTH AT EAST MILLCREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUGHRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-0123
Mailing Address - Street 1:1871 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3969
Mailing Address - Country:US
Mailing Address - Phone:801-485-0123
Mailing Address - Fax:801-485-0234
Practice Address - Street 1:1871 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3969
Practice Address - Country:US
Practice Address - Phone:801-485-0123
Practice Address - Fax:801-485-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-ALII-976310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility