MEDICARE: ENSIGN PEAK SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	10522 AND 10523	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124139654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSIGN PEAK SERVICES INC.

Provider Business Mailing Address
First Line	:	3270 MEADOWBROOK DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-5165
Country	:	US
Telephone Number	:	801-982-0716
Fax Number	:	801-965-8340

Provider Business Practice Location Address
First Line	:	2880 W 4700 S
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-2156
Country	:	US
Telephone Number	:	801-982-1404
Fax Number	:	801-982-1365

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. DIANNA G. HUSSEY
Credential	:
Telephone Number	:	801-982-1404

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “ENSIGN PEAK SERVICES INC. ” Practice Location

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