Provider Demographics
NPI:1104068659
Name:THE CHARLESTON AT CEDAR HILLS
Entity type:Organization
Organization Name:THE CHARLESTON AT CEDAR HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGGAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-772-0123
Mailing Address - Street 1:10020 N 4600 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8832
Mailing Address - Country:US
Mailing Address - Phone:801-772-0123
Mailing Address - Fax:801-772-0127
Practice Address - Street 1:10020 N 4600 W
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8832
Practice Address - Country:US
Practice Address - Phone:801-772-0123
Practice Address - Fax:801-772-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2009-ALII-87229310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility