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NPI Code Detail

MEDICARE: CLANCY NURSING AND REHAB CENTER LLC

MEDICARE: CLANCY NURSING AND REHAB CENTER LLC
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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist
4261Q00000XClinic/Center
5261QH0700XHearing and Speech Clinic/Center
6261QP2000XPhysical Therapy Clinic/Center
7261QX0100XOccupational Medicine Clinic/Center
8314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1700495496
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLANCY NURSING AND REHAB CENTER LLC
Provider Business Mailing Address
First Line : 1376 E 3300 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3069
Country : US
Telephone Number : 801-601-1450
Fax Number :
Provider Business Practice Location Address
First Line : 474 HIGHWAY 282
Second Line :
City : CLANCY
State : MT
Zip : 59634-9519
Country : US
Telephone Number : 801-601-1450
Fax Number :
Authorized Official
Title or Position : GENERAL COUNSEL
Name : DUSTIN MONROE
Credential :
Telephone Number : 385-240-6408
Provider Enumeration Date : 07/28/2020
Last Update Date : 10/23/2024

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