Provider Demographics
NPI:1740548205
Name:STONEHENGE CARE LLC
Entity type:Organization
Organization Name:STONEHENGE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
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:
Authorized Official - Phone:801-358-7625
Mailing Address - Street 1:791 W 800 S
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-4402
Mailing Address - Country:US
Mailing Address - Phone:801-358-7625
Mailing Address - Fax:801-489-6730
Practice Address - Street 1:791 W 800 S
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4402
Practice Address - Country:US
Practice Address - Phone:801-358-7625
Practice Address - Fax:801-489-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144554734Medicare UPIN
1922278142Medicare UPIN
1255612487Medicare UPIN