Healthcare Provider Details

I. General information

NPI: 1699051599
Provider Name (Legal Business Name): HAAGA MATTRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E 2100 S
SALT LAKE CITY UT
84115-2235
US

IV. Provider business mailing address

307 E 2100 S
SALT LAKE CITY UT
84115-2235
US

V. Phone/Fax

Practice location:
  • Phone: 801-485-1025
  • Fax: 801-410-4086
Mailing address:
  • Phone: 801-485-1025
  • Fax: 801-410-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateUT

VIII. Authorized Official

Name: JANESE HAAGA
Title or Position: OWNER
Credential:
Phone: 801-485-1025