Country Pines Memory Care, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

12-2014-509 Issued in UT

Legal business name

COUNTRY PINES MEMORY CARE, LLC

Doing business as

Country Pines Memory Care

Practice address

1748 W 1800 N
Clinton, UT 84015-8324

Phone

(801) 774-9198

Fax

(801) 825-3752

NPI assigned

Aug 17, 2016

Last updated

Aug 17, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patricia E Leavitt

Title

Executive Director

Phone

(801) 425-3271

Specialties & licenses 1

Addresses

Other names 1

• Country Pines Memory Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1336694546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1748 W 1800 N",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840158324",
            "telephone_number": "801-774-9198",
            "fax_number": "801-825-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1748 W 1800 N",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840158324",
            "telephone_number": "801-774-9198",
            "fax_number": "801-825-3752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY PINES MEMORY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-425-3271"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "UT",
            "license": "12-2014-509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Pines Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gerald Corey, RRT
• Erin Elizabethcotter Cotter, LMT
• Country Niche Adult Day Care
• Country Niche Adult Day Care LLC
• Country Niche Adult Day Center
• Country Pines Phase II LC
• Country Pines Retirement Home
• Kaden Craig, PT, DPT, CSCS
• Marcus Cressall, PHARM.D.
• Alyssa Crowe

• Alzheimer Center (Dementia Center) in Clinton, UT
• Providers in Clinton, UT by specialty
• Alzheimer Center (Dementia Center) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.