Healthcare Provider Details

I. General information

NPI: 1073514741
Provider Name (Legal Business Name): CANYON HILLS HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N 400 E
NEPHI UT
84648-2202
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: 435-623-1721
  • Fax: 435-623-5821
Mailing address:
  • Phone: 801-325-0153
  • Fax: 801-596-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2004-NCF-622
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FAYE LINCOLN
Title or Position: VP, POLICY/GOVERNMENT RELATIONS
Credential:
Phone: 801-325-0153