46D0998567 CLIA NUMBER - PINE CREEK REHAB AND NURSING

Laboratory Demographics

  • CLIA Code: 46D0998567
  • Facility Name: PINE CREEK REHAB AND NURSING
  • Facility Address: 876 W 700 S
    SALT LAKE CITY, UT
    ZIP 84104
  • Facility Phone: 801 355-9649
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: GUADALUPE O. PROCTOR
  • NPI Number: 1952708182
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 46D0998567
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PINE CREEK REHAB AND NURSING
Street 876 W 700 S
City SALT LAKE CITY
State UT
ZIP 84104
Phone 801 355-9649
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director GUADALUPE O. PROCTOR

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This page was last updated on: 9/29/2025