Basic Information
| Provider Information | |||||||||
| NPI: | 1407205727 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAINTREE GROVE HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE HEALTHCARE RESORT OF MURRAY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5250 SOUTH STATE STREET | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84107 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 27101 PUERTA REAL | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926918518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495401249 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2016 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | BURNAM | ||||||||
| AuthorizedOfficialFirstName: | SOON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9495401249 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | UT | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.