Healthcare Provider Details

I. General information

NPI: 1124139654
Provider Name (Legal Business Name): ENSIGN PEAK SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 W 4700 S SUITE B
SALT LAKE CITY UT
84118-2156
US

IV. Provider business mailing address

3270 MEADOWBROOK DR
SALT LAKE CITY UT
84119-5165
US

V. Phone/Fax

Practice location:
  • Phone: 801-982-1404
  • Fax: 801-982-1365
Mailing address:
  • Phone: 801-982-0716
  • Fax: 801-965-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number10522 AND 10523
License Number StateUT

VIII. Authorized Official

Name: MRS. DIANNA G. HUSSEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-982-1404