Provider Demographics
NPI:1356927834
Name:MEADOW PEAK SV LLC
Entity type:Organization
Organization Name:MEADOW PEAK SV LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MHS CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-389-1523
Mailing Address - Street 1:6084 SOUTH SUMMIT VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129
Mailing Address - Country:US
Mailing Address - Phone:385-255-1105
Mailing Address - Fax:
Practice Address - Street 1:6084 SOUTH SUMMIT VISTA BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129
Practice Address - Country:US
Practice Address - Phone:385-255-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility