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Contact Information

EAST LAKE CARE CENTER, LLC
101 N 500 W
PROVO, UT84601-2646
 Phone: 801-377-9661
 Fax: 801-377-9747
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility Supplies

332BN1400X 87 All Other Suppliers
 

Parenteral & Enteral Nutrition

332BP3500X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for EAST LAKE CARE CENTER, LLC

NPI Number 1326093261
LBN Legal business name EAST LAKE CARE CENTER, LLC
Authorized official CRAIG JOHNSON - (MEMBER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/22/2006
Last updated 01/03/2008 - About 18 years ago
Identifiers
UT License # 2004-NCF-292
UT License # 2007-NCF-292
UT Medicaid 870439756011
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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