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Organization
COUNTRY PINES PHASE II LC
Active
Organization
COUNTRY PINES PHASE II LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRNA L MCCLELLAN (ADMINISTRATOR)
(801) 773-0990
Entity
Organization
Contact information
Practice address
1706 W 1800 N, CLINTON, UT 84015-8324
(801) 773-0990
Mailing address
1706 W 1800 N, CLINTON, UT 84015-8324
(801) 773-0990
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
006871
UT
Other
Enumeration date
05/25/2007
Last updated
08/22/2020
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