Organization
COUNTRY LANE SANTAQUIN OPERATING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JARED ANDERSEN (OWNER)
(801) 928-3997
Entity
Organization
Contact information
Practice address
409 S 300 W, SANTAQUIN, UT 84655-8156
(801) 754-0813
(801) 754-1784
Mailing address
1133 N MAIN ST, SUITE 300, LAYTON, UT 84041-4800
(801) 546-7417
(801) 546-5230
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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