# COUNTRY PINES MEMORY CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Country Pines Memory Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336694546
- **Authorized official:** PATRICIA E LEAVITT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (801) 425-3271

## Contact information

- **Practice address:** 1748 W 1800 N, CLINTON, UT 84015-8324
- **Practice address phone:** (801) 774-9198
- **Practice address fax:** (801) 825-3752
- **Mailing address:** 1748 W 1800 N, CLINTON, UT 84015-8324
- **Mailing address phone:** (801) 774-9198
- **Mailing address fax:** (801) 825-3752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | 12-2014-509 | UT | Yes |

## Other

- **Enumeration date:** 08/17/2016
- **Last updated:** 08/17/2016