Trinity Mission Health & Rehab of Provo, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2006-NCF-43 Issued in UT

Legal business name

TRINITY MISSION HEALTH & REHAB OF PROVO, LP

Practice address

1053 W 1020 S
Provo, UT 84601-5656

Phone

(801) 373-2630

Fax

(801) 373-2660

NPI assigned

May 11, 2006

Organization subpart

Yes

Parent organization

COVENANT DOVE, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Judy Ullery

Title

President

Phone

(901) 937-7994

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1043260771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1053 W 1020 S",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846015656",
            "telephone_number": "801-373-2630",
            "fax_number": "801-373-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 W 1020 S",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846015656",
            "telephone_number": "801-373-2630",
            "fax_number": "801-373-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY MISSION HEALTH & REHAB OF PROVO, LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT DOVE, LLC",
        "enumeration_date": "2006-05-11",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "ULLERY",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-937-7994",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": "2006-NCF-43",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "990177577005",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Provo, UT
• Providers in Provo, UT by specialty
• Skilled Nursing Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.