Provider Demographics
NPI:1306038609
Name:DESERET NURSING AND REHABILITATION AT WELLINGTON
Entity Type:Organization
Organization Name:DESERET NURSING AND REHABILITATION AT WELLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:1600 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-4719
Mailing Address - Country:US
Mailing Address - Phone:620-623-2232
Mailing Address - Fax:
Practice Address - Street 1:1600 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4719
Practice Address - Country:US
Practice Address - Phone:620-623-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERET NURSING AND REHABILITATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility