Healthcare Provider Details

I. General information

NPI: 1336366913
Provider Name (Legal Business Name): VASLCHCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FOOTHILL BLVD
SLC UT
84148-0001
US

IV. Provider business mailing address

1732 N 2225 W
CLINTON UT
84015-7980
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 801-695-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number2239013102
License Number StateUT

VIII. Authorized Official

Name: MISS ANDREA Y BAKER
Title or Position: REGISTERED NURSE
Credential:
Phone: 801-582-1565