Provider Demographics
NPI:1225887268
Name:VICTOR REGIONS LLC
Entity type:Organization
Organization Name:VICTOR REGIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-645-1860
Mailing Address - Street 1:5828 PARK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-6779
Mailing Address - Country:US
Mailing Address - Phone:801-645-1860
Mailing Address - Fax:
Practice Address - Street 1:59 KING ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4630
Practice Address - Country:US
Practice Address - Phone:801-593-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4132459Medicaid