Provider Demographics
NPI:1982955860
Name:OQUIRRH MEADOWS CARE AND REHAB, INC
Entity Type:Organization
Organization Name:OQUIRRH MEADOWS CARE AND REHAB, INC
Other - Org Name:OQUIRRH MEADOWS ASSISTED LIVING AND MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-693-2400
Mailing Address - Street 1:2938 SO. REDWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST. VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119
Mailing Address - Country:US
Mailing Address - Phone:801-699-6031
Mailing Address - Fax:
Practice Address - Street 1:2948 SO. REDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:801-699-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012-ALII-107331310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility