Provider Demographics
NPI:1548617467
Name:COTTAGE HEALTH CENTER LLC
Entity type:Organization
Organization Name:COTTAGE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDEM, CD, LCCE
Authorized Official - Phone:801-796-2229
Mailing Address - Street 1:394 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2052
Mailing Address - Country:US
Mailing Address - Phone:801-796-2229
Mailing Address - Fax:
Practice Address - Street 1:394 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2052
Practice Address - Country:US
Practice Address - Phone:801-796-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN POINT PROPERTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing