Provider Demographics
NPI:1710733720
Name:BEARTOOTH REHABILITATION AND NURSING LLC
Entity type:Organization
Organization Name:BEARTOOTH REHABILITATION AND NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-498-0195
Mailing Address - Street 1:947 S 500 E STE 105
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3392
Mailing Address - Country:US
Mailing Address - Phone:385-492-0194
Mailing Address - Fax:801-492-8036
Practice Address - Street 1:350 W PIKE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-7617
Practice Address - Country:US
Practice Address - Phone:385-492-0194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility