Provider Demographics
NPI:1467450775
Name:ASPEN CARE CENTER INC
Entity Type:Organization
Organization Name:ASPEN CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREINHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-486-2348
Mailing Address - Street 1:PO BOX 65788
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84165-0788
Mailing Address - Country:US
Mailing Address - Phone:801-486-2348
Mailing Address - Fax:801-466-8961
Practice Address - Street 1:2325 MADISON AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1618
Practice Address - Country:US
Practice Address - Phone:801-399-5846
Practice Address - Fax:801-621-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870374578007Medicaid
UT870374578007Medicaid