Provider Demographics
NPI:1588843395
Name:BODO, LORANT STEVE
Entity Type:Individual
Prefix:
First Name:LORANT
Middle Name:STEVE
Last Name:BODO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 CHARROS RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4815
Mailing Address - Country:US
Mailing Address - Phone:801-495-1086
Mailing Address - Fax:
Practice Address - Street 1:463 WEST RAWLINS CIRCLE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014
Practice Address - Country:US
Practice Address - Phone:801-397-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2558310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility