Provider Demographics
NPI:1578882403
Name:MOUNTAIN LAND REHABILITATION HOME HEALTH, LC
Entity Type:Organization
Organization Name:MOUNTAIN LAND REHABILITATION HOME HEALTH, LC
Other - Org Name:ASHBY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JANETTE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-478-2521
Mailing Address - Street 1:11576 S STATE ST STE 1202B
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7119
Mailing Address - Country:US
Mailing Address - Phone:801-478-2521
Mailing Address - Fax:801-797-8667
Practice Address - Street 1:11576 S STATE ST STE 1202B
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7119
Practice Address - Country:US
Practice Address - Phone:801-478-2521
Practice Address - Fax:801-797-8667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN LAND REHABILITATION HOME HEALTH, LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-17
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health