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NPI Code Detail

MEDICARE: BENNION CARE CENTER, LLC

MEDICARE: BENNION CARE 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
1314000000XSkilled Nursing Facility2005-NCF-510UT

General Provider Information

NPI Number : 1750382412
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENNION CARE CENTER, LLC
Provider Business Mailing Address
First Line : 206 N 2100 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-4740
Country : US
Telephone Number : 801-325-0153
Fax Number : 801-596-9001
Provider Business Practice Location Address
First Line : 6246 S REDWOOD RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84123-6600
Country : US
Telephone Number : 801-969-1420
Fax Number : 801-955-2540
Authorized Official
Title or Position : VP, POLICY/GOVERNMENT RELATIONS
Name : FAYE LINCOLN
Credential :
Telephone Number : 801-325-0153
Provider Enumeration Date : 08/03/2005
Last Update Date : 09/26/2014

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