Provider Demographics
NPI:1558113480
Name:MONTECITO COMMUNITY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MONTECITO COMMUNITY HEALTHCARE LLC
Other - Org Name:SKYE CANYON POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:262 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2975
Mailing Address - Country:US
Mailing Address - Phone:385-342-5175
Mailing Address - Fax:
Practice Address - Street 1:6650 GRAND MONTECITO PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0210
Practice Address - Country:US
Practice Address - Phone:702-333-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility