NPIMap

Organization Active NPI

Milford Memorial Hospital

Doing business as Monument Healthcare Millcreek

  • Skilled Nursing Facility
  • Salt Lake City, UT
National Provider Identifier
1699533497
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MILFORD MEMORIAL HOSPITAL
Doing business as
Monument Healthcare Millcreek
Practice address
1201 E 4500 S
Salt Lake City, UT 84117-4124
Phone
(949) 687-0233
NPI assigned
Mar 7, 2024
Last updated
May 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Authorized official

Name
Tyler Moss
Title
Cfo
Phone
(435) 438-7209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1201 E 4500 S
Salt Lake City, UT 84117-4124

Mailing address

PO Box 640
Milford, UT 84751-0640
Phone (435) 387-2411

Other identifiers 1

IdentifierTypeStateIssuer
2024-NCF-F23-106569OtherUTLICENSURE

Other names 1

  • Monument Healthcare Millcreek Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250123003111 UT Part A Provider - Skilled Nursing Facility 8426955055 Practice locations: Millcreek, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699533497. Details of each certification follow.

Skilled nursing facility certification: CCN 465139

Legal name
MILFORD MEMORIAL HOSPITAL
Doing business as
MONUMENT HEALTHCARE MILLCREEK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 15, 1994
Last certification
Nov 2, 2023
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Monument Health Group
Organization structure
LLCProprietary
Enrollment address
1201 E 4500 S
Millcreek, UT 84117-4124
Nursing home name
MONUMENT HEALTHCARE MILLCREEK
Affiliated entity
MONUMENT HEALTH GROUP

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Monument Healthcare MillcreekCCN 465139 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 15, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12084.1 residents per day on average
Chain
Monument Health Group11 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D0887884Monument Healthcare Millcreek1201 E 4500 S, Salt Lake City, UT 84117Certificate of waiverJun 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Milford Valley Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christian R West Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Brandon Wiseman Individual Operational/Managerial Control Dec 6, 2024
Organization, Laguna Beach, CA LLC Adp of the SNF Jan 23, 2025
Indirect Ownership Interest Feb 1, 2024
Beaver Valley Hospital Organization, Beaver, UT Non-profit Operational/Managerial Control Dec 6, 2024
Brenda Izatt Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Milford Area Health Care Service District #3 Organization, Milford, UT Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Guy Dansie Individual Corporate OfficerCoo Feb 1, 2024
Adp of the SNF Jan 23, 2025
Scott a Langford Individual Corporate OfficerCeo Feb 1, 2024
Adp of the SNF Jan 23, 2025
Richard E Allen Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Spencer R Samuelian Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Travis Devashrayee Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Stephanie Espinosa Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Scott Symond Individual Operational/Managerial Control Dec 6, 2024
Monument Health Properties LLC Organization, Laguna Beach, CA Created for acquisition 5% Or Greater Mortgage Interest Feb 1, 2024 100%
Adp of the SNF Jan 23, 2025
Laurel Carter Individual Operational/Managerial Control Dec 6, 2024
Jason J Seastrand Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Shauna Mayer Individual Operational/Managerial Control Dec 6, 2024
Lindsay Fragoso Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Monument Real Estate Millcreek LLC Organization, Laguna Beach, CA Created for acquisition, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 1, 2024 100%
Adp of the SNF Jan 23, 2025
Brett P Robertson Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Tyler Moss Individual Corporate OfficerCfo Feb 1, 2024
Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Ward Dotson Individual Operational/Managerial Control Dec 6, 2024
Travis Clawson Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Health Group Management LLC Organization, Laguna Beach, CA Management services company Operational/Managerial Control Dec 5, 2024
Adp of the SNF Jan 23, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Milford Memorial HospitalLogan, UT, CCN 465079 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 2, 2022
Monument Healthcare BountifulBountiful, UT, CCN 465112 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF
Direct Ownership Interest (100%)		 Feb 1, 2024
Feb 1, 2024
Mar 6, 2025
Feb 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Milford Memorial Hospital

    dba Sunshine Terrace Skilled Nursing

    • Skilled Nursing Facility
    • Logan, UT
    • NPI 1063194876

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Milford Memorial Hospital

    dba Monument Healthcare Bountiful

    • Skilled Nursing Facility
    • Bountiful, UT
    • NPI 1841058641

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 62

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 62

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1699533497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "MILFORD",
            "state": "UT",
            "postal_code": "847510640",
            "telephone_number": "435-387-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E 4500 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174124",
            "telephone_number": "949-687-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILFORD MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-438-7209"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSURE",
            "identifier": "2024-NCF-F23-106569",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Monument Healthcare Millcreek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monument Healthcare Millcreek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.