Provider Demographics
NPI:1184912685
Name:KETCHER MANAGEMENT SERVICES
Entity type:Organization
Organization Name:KETCHER MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-809-4884
Mailing Address - Street 1:8434 SPRATLING DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-1751
Mailing Address - Country:US
Mailing Address - Phone:801-381-2041
Mailing Address - Fax:801-495-3101
Practice Address - Street 1:711 PIONEER RD
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9319
Practice Address - Country:US
Practice Address - Phone:801-495-3100
Practice Address - Fax:801-495-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2011-AL11-95437310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility