Healthcare Provider Details

I. General information

NPI: 1326680869
Provider Name (Legal Business Name): RONALD MCDONALD HOUSE OF THE INTERMOUNTAIN AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 E. SOUTH TEMPLE
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

935 E. SOUTH TEMPLE
SALT LAKE CITY UT
84102
US

V. Phone/Fax

Practice location:
  • Phone: 801-363-4663
  • Fax:
Mailing address:
  • Phone: 801-363-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CARRIE A ROMANO
Title or Position: CEO
Credential:
Phone: 801-363-4663