Provider Demographics
NPI:1306901194
Name:SMC WILLOW CREEK, LLC
Entity type:Organization
Organization Name:SMC WILLOW CREEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:NIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-733-6363
Mailing Address - Street 1:8325 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1000
Mailing Address - Country:US
Mailing Address - Phone:801-733-6363
Mailing Address - Fax:801-733-6362
Practice Address - Street 1:8325 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1000
Practice Address - Country:US
Practice Address - Phone:801-733-6363
Practice Address - Fax:801-733-6362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR MANAGEMENT CONCEPTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-22
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-ALII-23016310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility