1093422370 NPI number — CASCADES AT DESERT VIEW, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093422370 NPI number — CASCADES AT DESERT VIEW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADES AT DESERT VIEW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093422370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5314 N RIVER RUN DR STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-426-4905
Provider Business Mailing Address Fax Number:
801-426-4953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 SPRAGUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUHL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83316-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-543-6401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCSPADDEN
Authorized Official First Name:
DARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-426-4905

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)