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NPI Code Detail

MEDICARE: SALT LAKE BEHAVIORAL HEALTH

MEDICARE: SALT LAKE BEHAVIORAL HEALTH
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
1283Q00000XPsychiatric Hospital225374-4405UT

General Provider Information

NPI Number : 1053666883
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALT LAKE BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6000
Fax Number : 801-264-6070
Provider Business Practice Location Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6000
Fax Number : 801-264-6070
Authorized Official
Title or Position : NP
Name : MS. SUSAN ANN SHORT
Credential : NP
Telephone Number : 801-264-6000
Provider Enumeration Date : 07/18/2012
Last Update Date : 08/21/2012

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Directions to “SALT LAKE BEHAVIORAL HEALTH ” Practice Location

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