Doctor Name: | VICTOR CLARK |
NPI Number: | 1649687948 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 2014-ALIIUT000651 |
Business Practice Address: | 6352 W 13100 S Herriman, UT - 84096 |
Business Phone Number: | 8019031040 |
Business Fax Number: | 8014466293 |
Mailing Address: | 6352 W 13100 S, HERRIMAN |
State: | UT |
Postal Code: | 84096 |
Phone Number: | 8019031040 |
Fax Number: | 8014466293 |
NPI Enumeration Date: | 07/18/2014 |
NPI Last Update Date: | 07/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | 2014-ALIIUT000651 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |