Provider Demographics
NPI:1922278142
Name:STONEHENGE OF OREM, LLC
Entity Type:Organization
Organization Name:STONEHENGE OF OREM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:YEATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-367-6938
Mailing Address - Street 1:PO BOX 2316
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-2316
Mailing Address - Country:US
Mailing Address - Phone:801-850-5454
Mailing Address - Fax:801-850-5455
Practice Address - Street 1:435 WEST CENTER STREET
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058
Practice Address - Country:US
Practice Address - Phone:801-850-5454
Practice Address - Fax:801-850-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2009-02-27
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
UT465167Medicare Oscar/Certification