Healthcare Provider Details

I. General information

NPI: 1811633811
Provider Name (Legal Business Name): SLRMC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTH TEMPLE
SALT LAKE CITY UT
84102-1507
US

IV. Provider business mailing address

1050 E SOUTH TEMPLE
SALT LAKE CITY UT
84102-1507
US

V. Phone/Fax

Practice location:
  • Phone: 801-350-4111
  • Fax:
Mailing address:
  • Phone: 801-350-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GINGRAS
Title or Position: DIVISION CFO
Credential:
Phone: 801-568-5995