MEDICARE: FIDUCIARY HOLDINGS GROUP, 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	251B00000X	Case Management Agency	16098	UT

General Provider Information

NPI Number	:	1497079719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDUCIARY HOLDINGS GROUP, INC.

Provider Business Mailing Address
First Line	:	2995 S WEST TEMPLE
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-3658
Country	:	US
Telephone Number	:	801-466-4484
Fax Number	:	801-466-4472

Provider Business Practice Location Address
First Line	:	2995 S WEST TEMPLE
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-3658
Country	:	US
Telephone Number	:	801-466-4484
Fax Number	:	801-466-4472

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. PAUL J GOODWIN
Credential	:
Telephone Number	:	801-466-4484

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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