Provider Demographics
NPI:1629217948
Name:LOMOND PEAK CARE AND REHAB, INC
Entity Type:Organization
Organization Name:LOMOND PEAK CARE AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5106
Mailing Address - Street 1:524 E 800 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3600
Mailing Address - Country:US
Mailing Address - Phone:801-782-3740
Mailing Address - Fax:801-782-3594
Practice Address - Street 1:524 E 800 N
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3600
Practice Address - Country:US
Practice Address - Phone:801-782-3740
Practice Address - Fax:801-782-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-NCF-22014314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870579864007Medicaid
UT465065Medicare Oscar/Certification