Provider Demographics
NPI:1194715789
Name:EMERY COUNTY CARE AND REHABILITATION CENTER
Entity type:Organization
Organization Name:EMERY COUNTY CARE AND REHABILITATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUINTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-384-2301
Mailing Address - Street 1:P.O. BOX 936
Mailing Address - Street 2:455 W MILL RD
Mailing Address - City:FERRON
Mailing Address - State:UT
Mailing Address - Zip Code:84523-0936
Mailing Address - Country:US
Mailing Address - Phone:435-384-2301
Mailing Address - Fax:435-384-3013
Practice Address - Street 1:455 WEST MILL ROAD
Practice Address - Street 2:
Practice Address - City:FERRON
Practice Address - State:UT
Practice Address - Zip Code:84523-0936
Practice Address - Country:US
Practice Address - Phone:435-384-2301
Practice Address - Fax:435-384-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT690870111001Medicaid
UT465085Medicare ID - Type Unspecified