Provider Demographics
NPI:1790029056
Name:DESERET HEALTH AND REHAB AT CROSSLANDS LLC
Entity Type:Organization
Organization Name:DESERET HEALTH AND REHAB AT CROSSLANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:575 E 11000 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5326
Mailing Address - Country:US
Mailing Address - Phone:801-571-7600
Mailing Address - Fax:
Practice Address - Street 1:575 E 11000 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5326
Practice Address - Country:US
Practice Address - Phone:801-571-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DNR TWO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-26
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT522085558018Medicaid
UT522085558018Medicaid