Healthcare Provider Details

I. General information

NPI: 1528128899
Provider Name (Legal Business Name): WASATCH HOMELESS HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 04/24/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 400 S
SALT LAKE CITY UT
84101-1135
US

IV. Provider business mailing address

409 W 400 S
SALT LAKE CITY UT
84101-1135
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-0058
  • Fax: 801-364-0161
Mailing address:
  • Phone: 801-364-0058
  • Fax: 801-364-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANIDA EMERSON
Title or Position: CEO
Credential:
Phone: 801-364-0058