Provider Demographics
NPI:1053728543
Name:EHS CENTERVILLE LLC
Entity type:Organization
Organization Name:EHS CENTERVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RASBAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-683-6521
Mailing Address - Street 1:463 RAWLINS CIR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2104
Mailing Address - Country:US
Mailing Address - Phone:801-683-6521
Mailing Address - Fax:
Practice Address - Street 1:463 RAWLINS CIR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2104
Practice Address - Country:US
Practice Address - Phone:801-683-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2014-ALI-82394310400000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care