| Organization Name: | EHS CENTERVILLE LLC |
| NPI Number: | 1053728543 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW RASBAND (PRESIDENT) |
| Mailing Address: | 463 Rawlins Cir Centerville |
| State: | UT US |
| Postal Code: | 840142104 |
| Phone Number: | 8016836521 |
| Fax Number: | |
| NPI Enumeration Date: | 07/16/2014 |
| NPI Last Update Date: | 07/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 2014-ALI-82394 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |