Healthcare Provider Details

I. General information

NPI: 1689913451
Provider Name (Legal Business Name): LANDMARK HOSPITAL OF SALT LAKE CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 S BIRKHILL BLVD
MURRAY UT
84107-5715
US

IV. Provider business mailing address

PO BOX 267
JACKSON MO
63755-0267
US

V. Phone/Fax

Practice location:
  • Phone: 385-234-0944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number2013-HOSP-UT000575
License Number StateUT

VIII. Authorized Official

Name: MR. SCOTT BLAKLEY
Title or Position: CEO
Credential:
Phone: 385-234-0944