Provider Demographics
NPI:1871373878
Name:CC SENIOR LIVING LLC
Entity type:Organization
Organization Name:CC SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-834-3039
Mailing Address - Street 1:1011 S 1200 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1524
Mailing Address - Country:US
Mailing Address - Phone:801-834-3039
Mailing Address - Fax:
Practice Address - Street 1:432 W 1325 N
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7720
Practice Address - Country:US
Practice Address - Phone:435-867-8641
Practice Address - Fax:435-867-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness