Provider Demographics
NPI:1225454028
Name:MISSION HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MISSION HEALTH SERVICES INC
Other - Org Name:MISSION AT COMMUNITY LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-389-1523
Mailing Address - Street 1:2825 VIRGINIA WAY
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 WEST 400 SOUTH
Practice Address - Street 2:
Practice Address - City:CENTERFIELD
Practice Address - State:UT
Practice Address - Zip Code:84622-0260
Practice Address - Country:US
Practice Address - Phone:435-528-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility