Provider Demographics
NPI:1235377201
Name:HUTCHINSON CARE CENTER LLC
Entity Type:Organization
Organization Name:HUTCHINSON CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5149
Mailing Address - Street 1:500 N MARKET PLACE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1708
Mailing Address - Country:US
Mailing Address - Phone:801-296-5105
Mailing Address - Fax:801-382-1098
Practice Address - Street 1:500 N MARKET PLACE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1708
Practice Address - Country:US
Practice Address - Phone:801-296-5105
Practice Address - Fax:801-382-1098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DNR TWO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS423240314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175236Medicaid
KS175236Medicare PIN