Healthcare Provider Details

I. General information

NPI: 1487808366
Provider Name (Legal Business Name): WILLOW GLEN HEALTH & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 N 200 E
BRIGHAM CITY UT
84302-1303
US

IV. Provider business mailing address

206 N 2100 W SUITE 200
SALT LAKE CITY UT
84116-4740
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-7777
  • Fax:
Mailing address:
  • Phone: 801-325-0153
  • Fax: 801-596-0909

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: FAYE LINCOLN
Title or Position: VICE PRES. POLICY & GOV. RELATIONS
Credential:
Phone: 801-325-0153