MEDICARE: DESERET NURSING AND REHABILITATION AT YATES CENTER, 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
1	314000000X	Skilled Nursing Facility	N104001	KS

Other Identifiers

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

General Provider Information

NPI Number	:	1851398440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERET NURSING AND REHABILITATION AT YATES CENTER, INC

Provider Business Mailing Address
First Line	:	801 S FRY ST
Second Line	:
City	:	YATES CENTER
State	:	KS
Zip	:	66783-1640
Country	:	US
Telephone Number	:	620-625-2111
Fax Number	:	620-625-3630

Provider Business Practice Location Address
First Line	:	801 S FRY ST
Second Line	:
City	:	YATES CENTER
State	:	KS
Zip	:	66783-1640
Country	:	US
Telephone Number	:	620-625-2111
Fax Number	:	620-625-3630

Authorized Official
Title or Position	:	OWNER
Name	:	JON ROBERTSON
Credential	:
Telephone Number	:	801-296-5105

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/11/2008

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