Healthcare Provider Details

I. General information

NPI: 1215403456
Provider Name (Legal Business Name): SENIOR CHARITY CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S 2200 W STE B
WEST VALLEY CITY UT
84119-8411
US

IV. Provider business mailing address

721 N MAIN ST # 106
LAYTON UT
84041-2231
US

V. Phone/Fax

Practice location:
  • Phone: 801-515-0480
  • Fax:
Mailing address:
  • Phone: 801-515-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: TERRY FOUST
Title or Position: PRESIDENT
Credential:
Phone: 801-718-2563