Provider Demographics
NPI:1508865825
Name:SANDY REGIONAL, INC.
Entity type:Organization
Organization Name:SANDY REGIONAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-624-6230
Mailing Address - Street 1:4020 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3906
Mailing Address - Country:US
Mailing Address - Phone:916-624-6230
Mailing Address - Fax:916-624-6249
Practice Address - Street 1:50 E 9000 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2201
Practice Address - Country:US
Practice Address - Phone:801-561-9839
Practice Address - Fax:801-565-0483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORIZON WEST HEALTHCARE OF UTAH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005NCF82314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870418553002Medicaid
UT465111Medicare Oscar/Certification
UT0684900001Medicare NSC