MEDICARE: TURN COMMUNITY SERVICE

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	251C00000X	Developmentally Disabled Services Day Training Agency	11366	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11366	OTHER	UT	OFFICE OF LICENSING

General Provider Information

NPI Number	:	1699815803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TURN COMMUNITY SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 1287
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84110-1287
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 S MAIN ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2922
Country	:	US
Telephone Number	:	801-359-8876
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PHILLIP SHUMWAY
Credential	:
Telephone Number	:	801-359-8876

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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