Provider Demographics
NPI:1265828271
Name:DE MOISY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:DE MOISY HEALTHCARE, INC.
Other - Org Name:HARRISON POINTE HEALTHCARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-487-9500
Mailing Address - Street 1:3430 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1231
Mailing Address - Country:US
Mailing Address - Phone:801-399-5609
Mailing Address - Fax:801-627-1808
Practice Address - Street 1:3430 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1231
Practice Address - Country:US
Practice Address - Phone:801-399-5609
Practice Address - Fax:801-627-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465009Medicare Oscar/Certification