Provider Demographics
NPI:1578850590
Name:COTTONWOOD CREEK MSL, LLC
Entity Type:Organization
Organization Name:COTTONWOOD CREEK MSL, LLC
Other - Org Name:COTTONWOOD CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-242-1400
Mailing Address - Street 1:175 TECHNOLOGY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2478
Mailing Address - Country:US
Mailing Address - Phone:949-242-1400
Mailing Address - Fax:
Practice Address - Street 1:1245 MURRAY HOLLADAY RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4992
Practice Address - Country:US
Practice Address - Phone:801-263-0999
Practice Address - Fax:801-262-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2011-ALI-88423310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility