Healthcare Provider Details

I. General information

NPI: 1649820341
Provider Name (Legal Business Name): ANDERSON CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 N 1700 W
FARR WEST UT
84404-3498
US

IV. Provider business mailing address

1295 N 1700 W
FARR WEST UT
84404-3498
US

V. Phone/Fax

Practice location:
  • Phone: 435-720-7295
  • Fax:
Mailing address:
  • Phone: 435-720-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: HANNAH FAYE ANDERSON
Title or Position: NURSE ADMINISTRATOR
Credential: RN
Phone: 435-720-7295