Provider Demographics
NPI:1972781946
Name:AMERICAN FORK CARE CENTER LLC
Entity Type:Organization
Organization Name:AMERICAN FORK CARE CENTER LLC
Other - Org Name:HERITAGE HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-756-5293
Mailing Address - Street 1:350 EAST 300 NORTH
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-756-5293
Mailing Address - Fax:801-756-4144
Practice Address - Street 1:350 EAST 300 NORTH
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-756-5293
Practice Address - Fax:801-756-4144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVALON HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006ALI253310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility