Provider Demographics
NPI:1548420748
Name:ELK MEADOWS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:ELK MEADOWS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-675-3925
Mailing Address - Street 1:4200 NORTH 400 WEST
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055
Mailing Address - Country:US
Mailing Address - Phone:435-783-5575
Mailing Address - Fax:435-783-5588
Practice Address - Street 1:4200 NORTH 400 WEST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:UT
Practice Address - Zip Code:84055
Practice Address - Country:US
Practice Address - Phone:435-783-5575
Practice Address - Fax:435-783-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-ALII-80781310400000X
UT2010-ALII-80781310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility