Healthcare Provider Details

I. General information

NPI: 1114257193
Provider Name (Legal Business Name): ROCKY MOUNTAIN CARE - HOLLADAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 COLLEGE DR SUITE 205
MURRAY UT
84123-2653
US

IV. Provider business mailing address

5242 COLLEGE DR SUITE 205
MURRAY UT
84123-2653
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-4011
  • Fax: 801-397-4090
Mailing address:
  • Phone: 801-397-4011
  • Fax: 801-397-4090

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: DEE R BANGERTER
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 801-397-4011