Provider Demographics
NPI:1063756328
Name:DESERET HEALTH AND REHAB AT FEDERAL HEIGHTS LLC
Entity type:Organization
Organization Name:DESERET HEALTH AND REHAB AT FEDERAL HEIGHTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:41 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1306
Mailing Address - Country:US
Mailing Address - Phone:801-532-3539
Mailing Address - Fax:
Practice Address - Street 1:41 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1306
Practice Address - Country:US
Practice Address - Phone:801-532-3539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DNR TWO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-26
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT522085558066Medicaid
UT522085558066Medicaid