Healthcare Provider Details

I. General information

NPI: 1689037566
Provider Name (Legal Business Name): SALT LAKE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 S 700 E
SALT LAKE CITY UT
84106-1182
US

IV. Provider business mailing address

3802 S 700 E
SALT LAKE CITY UT
84106-1182
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-6000
  • Fax:
Mailing address:
  • Phone: 801-264-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300