Healthcare Provider Details

I. General information

NPI: 1144673013
Provider Name (Legal Business Name): NEIGHBORHOOD HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 SOUTH 1100 WEST
SALT LAKE CITY UT
84104
US

IV. Provider business mailing address

1050 W 500 S
SALT LAKE CITY UT
84104-1319
US

V. Phone/Fax

Practice location:
  • Phone: 801-363-4593
  • Fax: 801-363-4591
Mailing address:
  • Phone: 801-363-4589
  • Fax: 801-363-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number3587864002
License Number StateUT

VIII. Authorized Official

Name: JENNIFER NUTTALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-363-4589