Provider Demographics
NPI:1477109585
Name:ASPEN SENIOR CENTER, LC
Entity Type:Organization
Organization Name:ASPEN SENIOR CENTER, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-607-2300
Mailing Address - Street 1:3410 N CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4546
Mailing Address - Country:US
Mailing Address - Phone:801-607-2300
Mailing Address - Fax:
Practice Address - Street 1:3410 N CANYON RD
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4546
Practice Address - Country:US
Practice Address - Phone:801-607-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care