Provider Demographics
NPI: | 1942907894 |
---|---|
Name: | KEEPSAKE COMPANIONS LLC |
Entity Type: | Organization |
Organization Name: | KEEPSAKE COMPANIONS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | SIONE |
Authorized Official - Middle Name: | LIU ELI |
Authorized Official - Last Name: | FONUA |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 801-600-9782 |
Mailing Address - Street 1: | 1420 S 900 W |
Mailing Address - Street 2: | |
Mailing Address - City: | SALT LAKE CITY |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84104-1625 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-600-9782 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1420 S 900 W |
Practice Address - Street 2: | |
Practice Address - City: | SALT LAKE CITY |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84104-1625 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-600-9782 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-02-10 |
Last Update Date: | 2023-02-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 251S00000X | Agencies | Community/Behavioral Health | |
No | 253Z00000X | Agencies | In Home Supportive Care | |
No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility | |
No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 385H00000X | Respite Care Facility | Respite Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
UT | 000000000 | Medicaid |