East Lake Care Center, Llc

LBN: East Lake Care Center, Llc
East Lake Care Center, Llc is an health care organization with primary practice located at 101 N 500 W , Provo UT 84601-2646. The organization recently has 3 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Skilled Nursing Facility, Suppliers / Nursing Facility Supplies, Suppliers / Parenteral & Enteral Nutrition. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty. East Lake Care Center, Llc can be contacted via phone (801) 377-9661, or through Johnson, Craig R via phone (801) 268-1122.

Contact Information

Primary practice address
101 N 500 W Provo UT 84601-2646
Phone: (801) 377-9661
Fax: (801) 377-9747
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Craig R
Phone: (801) 268-1122

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 2004-NCF-292 Utah
Suppliers / Nursing Facility Supplies 332BN1400X 2007-NCF-292 Utah
Suppliers / Parenteral & Enteral Nutrition 332BP3500X 2007-NCF-292 Utah

Profile Details

NPI number 1326093261
LBN Legal business name East Lake Care Center, Llc
DBA Doing business as
Authorized official Johnson, Craig R
Entity Organization
Organization subpart 1 No
Enumeration date May 22nd, 2006
Last updated Jan 3rd, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326093261 NPPES
Utah MEDICAID 870439756011

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