Healthcare Provider Details

I. General information

NPI: 1275465288
Provider Name (Legal Business Name): KIND CARE HEALTH CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S 300 W APT 1104
SALT LAKE CITY UT
84101-1845
US

IV. Provider business mailing address

160 S 300 W APT 1104
SALT LAKE CITY UT
84101-1845
US

V. Phone/Fax

Practice location:
  • Phone: 805-300-2866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIAMOND MANNERY
Title or Position: CLINIC MANAGER
Credential:
Phone: 805-300-2866