Provider Demographics
NPI:1891003182
Name:S-H OPCO SALT LAKE CITY, LLC
Entity Type:Organization
Organization Name:S-H OPCO SALT LAKE CITY, LLC
Other - Org Name:EMERITUS AT SALT LAKE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:OHLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:76 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1044
Mailing Address - Country:US
Mailing Address - Phone:801-359-0050
Mailing Address - Fax:801-359-0080
Practice Address - Street 1:76 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1044
Practice Address - Country:US
Practice Address - Phone:801-359-0050
Practice Address - Fax:801-359-0080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
465149Medicare Oscar/Certification