MEDICARE: WASATCH HOMELESS HEALTH CARE, 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	261QF0400X	Federally Qualified Health Center (FQHC)
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1912859224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH HOMELESS HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	409 W 400 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-1135
Country	:	US
Telephone Number	:	801-364-0058
Fax Number	:	801-364-0061

Provider Business Practice Location Address
First Line	:	8955 S HARRISON ST
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2055
Country	:	US
Telephone Number	:	801-364-0058
Fax Number	:

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	ANDRE GARNER
Credential	:
Telephone Number	:	801-364-0058

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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