Healthcare Provider Details

I. General information

NPI: 1154389203
Provider Name (Legal Business Name): ST GEORGE NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 S 1200 E
ST GEORGE UT
84790-5508
US

IV. Provider business mailing address

178 S 1200 E
ST GEORGE UT
84790-5508
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-1207
  • Fax: 435-688-8650
Mailing address:
  • Phone: 435-688-1207
  • Fax: 435-688-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2005-NCF-21909
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. TRAVIS HOOPES
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-688-1207