Provider Demographics
NPI:1952613192
Name:ARTHUR RETIREMENT COMMMUNITY
Entity Type:Organization
Organization Name:ARTHUR RETIREMENT COMMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DAVIN
Authorized Official - Last Name:FONNESBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-752-3734
Mailing Address - Street 1:747 RIVERWALK PKWY
Mailing Address - Street 2:APARTMENT 125
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5976
Mailing Address - Country:US
Mailing Address - Phone:435-752-3734
Mailing Address - Fax:
Practice Address - Street 1:747 RIVERWALK PKWY
Practice Address - Street 2:APARTMENT 125
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5976
Practice Address - Country:US
Practice Address - Phone:435-752-3734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-03
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77027310170251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health