Provider Demographics
NPI:1013994516
Name:MISSION HEALTH SERVICES
Entity Type:Organization
Organization Name:MISSION HEALTH SERVICES
Other - Org Name:ALPINE VALLEY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-389-1523
Mailing Address - Street 1:5007 S MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-9404
Mailing Address - Country:US
Mailing Address - Phone:816-232-9573
Mailing Address - Fax:816-232-9596
Practice Address - Street 1:25 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3511
Practice Address - Country:US
Practice Address - Phone:801-785-3568
Practice Address - Fax:801-785-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-NCF-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========000Medicaid
UT465088Medicare Oscar/Certification