MEDICARE: PAPPADAKIS ENTERPRISES

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	314000000X	Skilled Nursing Facility	2004-NCF-368	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124021050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAPPADAKIS ENTERPRISES

Provider Business Mailing Address
First Line	:	125 S 900 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1125
Country	:	US
Telephone Number	:	801-363-6340
Fax Number	:	801-359-8533

Provider Business Practice Location Address
First Line	:	125 S 900 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1125
Country	:	US
Telephone Number	:	801-363-6340
Fax Number	:	801-359-8533

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOHN N PAPPADAKIS
Credential	:	OWNER
Telephone Number	:	801-363-6340

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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Directions to “PAPPADAKIS ENTERPRISES ” Practice Location

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