Provider Demographics
NPI:1700949195
Name:ELDERLY MANOR ASSISTED LIVING
Entity Type:Organization
Organization Name:ELDERLY MANOR ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDENHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-571-1010
Mailing Address - Street 1:1009 MURRAY HOLLADAY RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4921
Mailing Address - Country:US
Mailing Address - Phone:801-268-6342
Mailing Address - Fax:801-576-1372
Practice Address - Street 1:1009 MURRAY HOLLADAY RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4921
Practice Address - Country:US
Practice Address - Phone:801-268-6342
Practice Address - Fax:801-576-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-ALI-239310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility