Organization
PROVIDENTIAL BBA OPERATING LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BROWN (CFO)
(801) 397-8145
Entity
Organization
Contact information
Practice address
481 SOUTH 400 EAST, BOUNTIFUL, UT 84010-3801
(801) 295-2361
Mailing address
485 E 500 S, BOUNTIFUL, UT 84010-3801
(801) 295-2361
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154842250
—
UT
Enumeration date
06/29/2017
Last updated
07/21/2022
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