East Lake Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2004-NCF-292 Issued in UT

Legal business name

EAST LAKE CARE CENTER, LLC

Practice address

101 N 500 W
Provo, UT 84601-2646

Phone

(801) 377-9661

Fax

(801) 377-9747

NPI assigned

May 22, 2006

Organization subpart

No

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

Authorized official

Name

Craig R Johnson

Title

Member

Phone

(801) 268-1122

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1326093261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 57850",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841570850",
            "telephone_number": "801-268-1122",
            "fax_number": "801-268-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846012646",
            "telephone_number": "801-377-9661",
            "fax_number": "801-377-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LAKE CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "801-268-1122"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": "2004-NCF-292",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "UT",
            "license": "2007-NCF-292",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "UT",
            "license": "2007-NCF-292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870439756011",
            "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 Jan 3, 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.