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General NPI Number Information
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NPI Number | 1982812459
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Entity Type | Organization
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Legal Business Name | RENAISSANCE REHABILITATION OF SOUTH JORDAN
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 1371 WEST SOUTH JORDAN PARKWAY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095
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Country | US
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Telephone | 801-920-9566
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Fax |
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Provider Business Mailing Address
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Address Line | 1043 RAYMOND RD
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City | FRUIT HEIGHTS
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State | UT
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Zip | 84037-2249
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Country | US
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Telephone | 801-444-3233
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHAD CROOKSTON
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Credential |
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Telephone | 801-920-9566
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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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