Healthcare Provider Details

I. General information

NPI: 1992548960
Provider Name (Legal Business Name): SALT LAKE SPECIALTY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 S BIRKHILL BLVD
MURRAY UT
84107-5715
US

IV. Provider business mailing address

700 17TH ST STE 205
MODESTO CA
95354-1249
US

V. Phone/Fax

Practice location:
  • Phone: 385-425-0050
  • Fax:
Mailing address:
  • Phone: 707-503-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MANPREET SINGH
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 707-503-8772