MEDICARE: PEAK SPECIALTY GROUP HOSPICE

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1841604675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK SPECIALTY GROUP HOSPICE

Provider Business Mailing Address
First Line	:	1220 E 3900 S STE 4D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1383
Country	:	US
Telephone Number	:	801-904-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 E 3900 S STE 4D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1383
Country	:	US
Telephone Number	:	801-904-2340
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MISS DANI POTTER
Credential	:	BA ADMINISTRATOR
Telephone Number	:	801-557-4031

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	11/12/2014

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