Healthcare Provider Details

I. General information

NPI: 1356391056
Provider Name (Legal Business Name): TRINITY MISSION HEALTH & REHAB OF ROY, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 5600 S
ROY UT
84067-1372
US

IV. Provider business mailing address

2700 W 5600 S
ROY UT
84067-1372
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-9731
  • Fax: 801-776-2018
Mailing address:
  • Phone: 801-825-9731
  • Fax: 801-776-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2005-NCF-468
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier930947176002
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: MRS. JUDY ULLERY
Title or Position: PRESIDENT
Credential:
Phone: 901-937-7994