Provider Demographics
NPI:1740604958
Name:KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Other - Org Name:STONEHENGE OF OGDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-358-7625
Mailing Address - Street 1:PO BOX 150372
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0372
Mailing Address - Country:US
Mailing Address - Phone:801-475-0500
Mailing Address - Fax:801-475-0700
Practice Address - Street 1:5648 SOUTH ADAMS AVENUE PARKWAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-960-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465182Medicare Oscar/Certification