Healthcare Provider Details

I. General information

NPI: 1093128738
Provider Name (Legal Business Name): HAMILTON HOUSE OREM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 WEST 500 NORTH
OREM UT
84057
US

IV. Provider business mailing address

370 WEST 500 NORTH
OREM UT
84057
US

V. Phone/Fax

Practice location:
  • Phone: 801-223-4344
  • Fax: 801-223-4348
Mailing address:
  • Phone: 801-223-4344
  • Fax: 801-223-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2013-NCF-47328
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number348575-1501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number348575-3102
License Number StateUT

VIII. Authorized Official

Name: MRS. JACKIE BRINGHURST
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-223-4344