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NPI Code Detail

MEDICARE: MR. FRANK MANLEY CHASE III PEER SUPPORT SPECIAL

MEDICARE: MR. FRANK MANLEY CHASE III PEER SUPPORT SPECIAL
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1831807403
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FRANK MANLEY CHASE III PEER SUPPORT SPECIAL
Provider Business Mailing Address
First Line : 344 E 100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1700
Country : US
Telephone Number : 801-875-1892
Fax Number :
Provider Business Practice Location Address
First Line : 344 E 100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1700
Country : US
Telephone Number : 801-428-3402
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2022
Last Update Date : 11/11/2022

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