Healthcare Provider Details

I. General information

NPI: 1609125715
Provider Name (Legal Business Name): THE PEAKS CARE AND REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 12/30/2013
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: 801-434-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier465177
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name: MR. CLINTON W. ROBERTSON
Title or Position: CEO
Credential:
Phone: 801-693-2400