MEDICARE: SALT LAKE OPERATIONS, LLC

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	314000000X	Skilled Nursing Facility	2004NCF665	UT

General Provider Information

NPI Number	:	1225061229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALT LAKE OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5751
Fax Number	:	423-339-8342

Provider Business Practice Location Address
First Line	:	1201 E 4500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4124
Country	:	US
Telephone Number	:	801-261-3664
Fax Number	:	801-261-3691

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	CINDY S CROSS
Credential	:
Telephone Number	:	423-473-5867

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/29/2015

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