Provider Demographics
NPI:1023311362
Name:DESERET CARE CENTER LLC
Entity type:Organization
Organization Name:DESERET CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:950 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2141
Mailing Address - Country:US
Mailing Address - Phone:801-486-5121
Mailing Address - Fax:801-486-5146
Practice Address - Street 1:950 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2141
Practice Address - Country:US
Practice Address - Phone:801-486-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DNR TWO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-08
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001989490Medicaid
UT=========001Medicaid
NV001989490Medicaid