Healthcare Provider Details

I. General information

NPI: 1366598716
Provider Name (Legal Business Name): ALPINE TRANSITIONAL REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 S 800 W
BRIGHAM CITY UT
84302-3042
US

IV. Provider business mailing address

997 S 800 W
BRIGHAM CITY UT
84302-3042
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-7629
  • Fax: 435-723-7941
Mailing address:
  • Phone: 435-723-7629
  • Fax: 435-723-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT H BREINHOLT
Title or Position: OWNER
Credential: PHD
Phone: 435-723-7629