Provider Demographics
NPI:1114257193
Name:ROCKY MOUNTAIN CARE - HOLLADAY, INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN CARE - HOLLADAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4011
Mailing Address - Street 1:5242 COLLEGE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2653
Mailing Address - Country:US
Mailing Address - Phone:801-397-4011
Mailing Address - Fax:801-397-4090
Practice Address - Street 1:5242 COLLEGE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2653
Practice Address - Country:US
Practice Address - Phone:801-397-4011
Practice Address - Fax:801-397-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility