Provider Demographics
NPI:1306105184
Name:DESERET HEALTH AND REHAB AT OGDEN LLC
Entity type:Organization
Organization Name:DESERET HEALTH AND REHAB AT OGDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-851-9534
Mailing Address - Street 1:524 E 800 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3600
Mailing Address - Country:US
Mailing Address - Phone:801-782-3740
Mailing Address - Fax:801-782-3594
Practice Address - Street 1:524 E 800 N
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3600
Practice Address - Country:US
Practice Address - Phone:801-782-3740
Practice Address - Fax:801-782-3594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DNR TWO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-14
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465065Medicare Oscar/Certification