Provider Demographics
NPI:1134424617
Name:STONEHENGE OF SOUTH JORDAN LLC
Entity type:Organization
Organization Name:STONEHENGE OF SOUTH JORDAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:801-960-6000
Mailing Address - Street 1:1371 WEST SOUTH JORDAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8848
Mailing Address - Country:US
Mailing Address - Phone:801-253-1370
Mailing Address - Fax:801-253-1395
Practice Address - Street 1:1371 WEST SOUTH JORDAN PARKWAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8848
Practice Address - Country:US
Practice Address - Phone:801-253-1370
Practice Address - Fax:801-253-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465176Medicare Oscar/Certification