MEDICARE: CAREGIVER SUPPORT NETWORK, INC

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	363LG0600X	Gerontology Nurse Practitioner		UT
2	251E00000X	Home Health Agency	2004-HHA-20903	UT

General Provider Information

NPI Number	:	1083610869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREGIVER SUPPORT NETWORK, INC

Provider Business Mailing Address
First Line	:	404 E 4500 S STE A24
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2756
Country	:	US
Telephone Number	:	801-747-2100
Fax Number	:	801-747-2104

Provider Business Practice Location Address
First Line	:	404 E 4500 S STE A24
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2756
Country	:	US
Telephone Number	:	801-747-2100
Fax Number	:	801-747-2104

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. CHRIS ANN WOODS
Credential	:	P.T.A.
Telephone Number	:	801-747-2100

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	09/20/2022

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