MEDICARE: ENSIGN PEAK SERVICES, 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	253J00000X	Foster Care Agency	15609-10	UT

General Provider Information

NPI Number	:	1417268673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSIGN PEAK SERVICES, INC.

Provider Business Mailing Address
First Line	:	2880 W 4700 S
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-2156
Country	:	US
Telephone Number	:	801-982-1404
Fax Number	:	801-982-1365

Provider Business Practice Location Address
First Line	:	2880 W 4700 S
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-2156
Country	:	US
Telephone Number	:	801-982-1404
Fax Number	:	801-982-1365

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. DIANNA G. HUSSEY
Credential	:
Telephone Number	:	801-982-1404

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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Directions to “ENSIGN PEAK SERVICES, INC. ” Practice Location

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