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NPI Code Detail

MEDICARE: SANDY REGIONAL, INC.

MEDICARE: SANDY REGIONAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility2005NCF82UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508865825
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANDY REGIONAL, INC.
Provider Business Mailing Address
First Line : 4020 SIERRA COLLEGE BLVD
Second Line : SUITE 190
City : ROCKLIN
State : CA
Zip : 95677-3906
Country : US
Telephone Number : 916-624-6230
Fax Number : 916-624-6249
Provider Business Practice Location Address
First Line : 50 E 9000 S
Second Line :
City : SANDY
State : UT
Zip : 84070-2201
Country : US
Telephone Number : 801-561-9839
Fax Number : 801-565-0483
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : LARRY E BEAR
Credential :
Telephone Number : 916-624-6230
Provider Enumeration Date : 07/19/2005
Last Update Date : 06/10/2008

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