Provider Demographics
NPI:1720823503
Name:POUDRE CANYON REHABILITATION AND NURSING, LLC
Entity type:Organization
Organization Name:POUDRE CANYON REHABILITATION AND NURSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-498-0194
Mailing Address - Street 1:947 S 500 E STE 105
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3392
Mailing Address - Country:US
Mailing Address - Phone:385-498-0194
Mailing Address - Fax:
Practice Address - Street 1:1000 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3914
Practice Address - Country:US
Practice Address - Phone:970-482-7925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility