Basic Information
Provider Information
NPI: 1033441597
EntityType: 2
ReplacementNPI:  
OrganizationName: ZIONS MOUNTAIN VIEW HOME & ASSOC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CANYON RIM CARE CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 255 E 400 S
Address2: SUITE 200
City: SALT LAKE CITY
State: UT
PostalCode: 841112846
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2730 E 3300 S
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841092819
CountryCode: US
TelephoneNumber: 8014870896
FaxNumber: 8014870912
Other Information
ProviderEnumerationDate: 02/09/2010
LastUpdateDate: 08/09/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LINCOLN
AuthorizedOfficialFirstName: FAYE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT POLICY & GOVT RELATI
AuthorizedOfficialTelephone: 8013250153
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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