Victor Clark
Individual provider Active NPI Assisted Living Facility · Herriman, UT
NPI 1649687948 · NPPES record last updated Jul 18, 2014
Key facts
- NPI
- 1649687948
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 2014-ALIIUT000651 (UT)
- Practice address
- 6352 W 13100 S
Herriman, UT 84096 - Phone
- (801) 903-1040
- Fax
- (801) 446-6293
- NPI assigned
- Jul 18, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014-ALIIUT000651 | UT | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apiary Management Group | Assisted Living Facility | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 2014-ALIIUT000651 | UT | Yes |
Addresses
Primary practice location
6352 W 13100 S
Herriman, UT 84096
Mailing address
6352 W 13100 S
Herriman, UT 84096
Phone (801) 903-1040
Other providers in Herriman, UT
- Children Deserve More
- Jamie Marie Chlarson
- Sharlene Christensen
- Ivy Christiansen
- Sheena Jo Christison
- Brett Morgan Clement
- Joylyn Cluny
- Mackenzie Diane Cook
- Brianna Kaye Coon
- Brandi Coons
All providers in Herriman, UT · Assisted Living Facility in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.