COUNTRY PINES MEMORY CARE, LLC — NPI 1336694546 (Licensed & Credentialed Alzheimer Center (Dementia Center) in CLINTON, UT)

CMS-1500 Box 24J / 33a • NPI

1336694546

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

311500000X

Licensed & Credentialed Alzheimer Center (Dementia Center)

Box 32 Service Location & ZIP+4

1748 W 1800 N, CLINTON, UT, 84015-8324

✓ 9-Digit EDI 837 ZIP+4 (84015-8324)

Practice Phone & Referral Fax

(801) 774-9198

Fax: (801) 825-3752

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1336694546 (COUNTRY PINES MEMORY CARE, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1336694546` (NPI-2 Organization / Facility)
Provider / Legal Name	COUNTRY PINES MEMORY CARE, LLC
Plain-English Specialty	Licensed & Credentialed Alzheimer Center (Dementia Center) NUCC Code: `311500000X` (Alzheimer Center (Dementia Center))
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1748 W 1800 N, CLINTON, UT, 84015-8324
Practice Telephone / Fax	Tel: (801) 774-9198 \| Fax: (801) 825-3752
Administrative Mailing Address	1748 W 1800 N, CLINTON, UT, 84015-8324
Enumeration & Last Sync	Enumerated: 2016-08-17 \| CMS Record Updated: 2016-08-17
Authorized Official	PATRICIA LEAVITT (Executive Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1748 W 1800 N, CLINTON, UT, 84015-8324

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Plain-English Taxonomy & CMS Crosswalk (311500000X)

What Does Taxonomy Code 311500000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 311500000X translates to:
"Licensed & Credentialed Alzheimer Center (Dementia Center)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Alzheimer Center (Dementia Center) for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (COUNTRY PINES MEMORY CARE, LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`311500000X` — Alzheimer Center (Dementia Center) Plain English: Licensed & Credentialed Alzheimer Center (Dementia Center)	State: UT \| License: `12-2014-509` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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COUNTRY PINES MEMORY CARE, LLC (NPI #1336694546)