North Parkway Healthcare, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

NORTH PARKWAY HEALTHCARE, INC.

Doing business as

Wide Horizons Intermediate Care Facility

Practice address

910 Monroe Blvd
Ogden, UT 84404-6434

Phone

(801) 399-5876

Fax

(801) 392-2955

NPI assigned

Apr 3, 2017

Last updated

May 1, 2017By 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

Soon Burnam

Title

Treasurer

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wide Horizons Intermediate Care Facility Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710419114. Details of each certification follow.

• CCN 46G012 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 46G012

Legal name

WIDE HORIZONS INTERMEDIATE CARE FACILITY

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Aug 27, 1980

Last certification

Apr 25, 2023

Beds

57

Ownership / control type

Private (proprietary)

Facility address

910 Monroe Boulevard
Ogden, UT 84404

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1710419114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 MONROE BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844046434",
            "telephone_number": "801-399-5876",
            "fax_number": "801-392-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MONROE BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844046434",
            "telephone_number": "801-399-5876",
            "fax_number": "801-392-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PARKWAY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE",
            "identifier": "89630",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wide Horizons Intermediate Care Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nursing Facility/Intermediate Care Facility in Ogden, UT
• Providers in Ogden, UT by specialty
• Nursing Facility/Intermediate Care Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.