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General NPI Number Information
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NPI Number | 1861034209
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Entity Type | Organization
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Legal Business Name | CANON CITY NURSING AND REHAB CENTER, LLC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 515 FAIRVIEW AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2863
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Country | US
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Telephone | 801-601-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 1376 E 3300 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-3069
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Country | US
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Telephone | 801-601-1450
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | BROOKE HIXSON
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Credential |
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Telephone | 801-941-3495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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