Provider Demographics
NPI:1447437421
Name:SANTE ASSISTED LIVING HEBER, LLD
Entity type:Organization
Organization Name:SANTE ASSISTED LIVING HEBER, LLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-752-6652
Mailing Address - Street 1:905 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3913
Mailing Address - Country:US
Mailing Address - Phone:435-657-2536
Mailing Address - Fax:
Practice Address - Street 1:905 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3913
Practice Address - Country:US
Practice Address - Phone:435-657-2536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT207325310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT208599168001Medicaid