Provider Demographics
NPI:1750759809
Name:OAK RIDGE ASSISTED LIVING
Entity type:Organization
Organization Name:OAK RIDGE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RORY
Authorized Official - Last Name:GROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-358-9458
Mailing Address - Street 1:463 RAWLINS CIR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2104
Mailing Address - Country:US
Mailing Address - Phone:801-295-3225
Mailing Address - Fax:
Practice Address - Street 1:463 RAWLINS CIR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2104
Practice Address - Country:US
Practice Address - Phone:801-295-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility