Provider Demographics
NPI:1194992354
Name:HEIRLOOM INN, INC.
Entity type:Organization
Organization Name:HEIRLOOM INN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION (FINANCE)
Authorized Official - Prefix:MR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-636-8441
Mailing Address - Street 1:145 N CARBON AVE
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2464
Mailing Address - Country:US
Mailing Address - Phone:435-636-8441
Mailing Address - Fax:435-613-8040
Practice Address - Street 1:145 N CARBON AVE
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2464
Practice Address - Country:US
Practice Address - Phone:435-636-8441
Practice Address - Fax:435-613-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-ALII-16260310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility