Provider Demographics
NPI:1760818264
Name:CANYON BREEZE SENIOR CARE LLC
Entity Type:Organization
Organization Name:CANYON BREEZE SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-372-1613
Mailing Address - Street 1:380 E 240 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4889
Mailing Address - Country:US
Mailing Address - Phone:801-226-8338
Mailing Address - Fax:801-235-0877
Practice Address - Street 1:380 E 240 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4889
Practice Address - Country:US
Practice Address - Phone:801-226-8338
Practice Address - Fax:801-235-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013-PCA-UT000607251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health