MEDICARE: JEWISH FAMILY SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	2436189	UT

General Provider Information

NPI Number	:	1043446370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICE

Provider Business Mailing Address
First Line	:	1111 BRICKYARD RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2560
Country	:	US
Telephone Number	:	801-746-4334
Fax Number	:	801-746-4334

Provider Business Practice Location Address
First Line	:	1111 BRICKYARD RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2560
Country	:	US
Telephone Number	:	801-746-4334
Fax Number	:	801-746-4334

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELLEN SILVER
Credential	:	LCSW
Telephone Number	:	801-746-4334

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	06/01/2009

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