Basic Information
| Provider Information | |||||||||
| NPI: | 1487808366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLOW GLEN HEALTH & REHAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 N 2100 W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841164740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013250153 | ||||||||
| FaxNumber: | 8015960909 | ||||||||
| Practice Location | |||||||||
| Address1: | 775 N 200 E | ||||||||
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| City: | BRIGHAM CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843021303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357237777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 06/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | LINCOLN | ||||||||
| AuthorizedOfficialFirstName: | FAYE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRES. POLICY & GOV. RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8013250153 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.