Healthcare Provider Details

I. General information

NPI: 1154985695
Provider Name (Legal Business Name): KPC PROMISE HOSPITAL OF SALT LAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 11/01/2021
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 S BIRKHILL BLVD
MURRAY UT
84107-5715
US

IV. Provider business mailing address

900 N FEDERAL HWY STE 350
BOCA RATON FL
33432-2754
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-7100
  • Fax:
Mailing address:
  • Phone: 561-869-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM THOMAS
Title or Position: SECRETARY
Credential:
Phone: 951-987-8100