Provider Demographics
NPI:1366185175
Name:POE, AIMEE JO (OWNER)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:JO
Last Name:POE
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S 2000 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-6935
Mailing Address - Country:US
Mailing Address - Phone:801-776-7000
Mailing Address - Fax:
Practice Address - Street 1:1407 S 2000 W
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-6935
Practice Address - Country:US
Practice Address - Phone:801-776-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT000778310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility