Provider Demographics
NPI:1912750506
Name:SUNFLOWER RIDGE ASSISTED LIVING
Entity Type:Organization
Organization Name:SUNFLOWER RIDGE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-404-1632
Mailing Address - Street 1:41 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2244
Mailing Address - Country:US
Mailing Address - Phone:801-404-1632
Mailing Address - Fax:323-389-2733
Practice Address - Street 1:41 E CENTER ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2244
Practice Address - Country:US
Practice Address - Phone:801-404-1632
Practice Address - Fax:323-389-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility