Provider Demographics
NPI:1699973461
Name:HIGHLAND COVE RETIREMENT COMMUNITY
Entity type:Organization
Organization Name:HIGHLAND COVE RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-272-8226
Mailing Address - Street 1:3750 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3206
Mailing Address - Country:US
Mailing Address - Phone:801-272-8226
Mailing Address - Fax:801-272-6811
Practice Address - Street 1:3750 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3206
Practice Address - Country:US
Practice Address - Phone:801-272-8226
Practice Address - Fax:801-272-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-ALI-255310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility