Deseret Health Group, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DESERET HEALTH GROUP, LLC

Practice address

190 S Main St
Bountiful, UT 84010-6234

Phone

(801) 296-5105

Fax

(801) 382-1098

NPI assigned

Feb 25, 2013

Last updated

Feb 25, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Garret Robertson

Title

Ceo

Phone

(801) 296-5105

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1558601773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 S MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106234",
            "telephone_number": "801-296-5105",
            "fax_number": "801-382-1098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 S MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106234",
            "telephone_number": "801-296-5105",
            "fax_number": "801-382-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERET HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "GARRET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-296-5105",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ryan Colby Despain, DPT
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• Shaun Claud Devoy
• Dicks Family Pharmacy Inc

• Skilled Nursing Facility in Bountiful, UT
• Providers in Bountiful, 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 Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.