Provider Demographics
NPI:1700072709
Name:MERIDIAN REHAB SERVICES CORP.
Entity Type:Organization
Organization Name:MERIDIAN REHAB SERVICES CORP.
Other - Org Name:MERIDIAN REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-295-8000
Mailing Address - Street 1:450 S 400 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4938
Mailing Address - Country:US
Mailing Address - Phone:801-295-8000
Mailing Address - Fax:801-295-8079
Practice Address - Street 1:450 S 400 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4938
Practice Address - Country:US
Practice Address - Phone:801-295-8000
Practice Address - Fax:801-295-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3140N1450X3140N1450X
NE3140N1450X3140N1450X
AZ3140N1450X3140N1450X
MN3140N1450X3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric