Healthcare Provider Details

I. General information

NPI: 1962252213
Provider Name (Legal Business Name): HOLBROOK HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 400 E
BOUNTIFUL UT
84010-4933
US

IV. Provider business mailing address

401 S 400 E
BOUNTIFUL UT
84010-4933
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-2361
  • Fax:
Mailing address:
  • Phone: 801-295-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249