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NPI Code Detail

MEDICARE: SJV, INC. A PROFESSIONAL CORPORATION

MEDICARE: SJV, INC. A PROFESSIONAL CORPORATION
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
1251S00000XCommunity/Behavioral Health Agency134414-3501UT

General Provider Information

NPI Number : 1568529188
Entity Type Code : Organization
Provider Name (Legal Business Name) : SJV, INC. A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 4505 WASATCH BLVD
Second Line : SUITE 320
City : SALT LAKE CITY
State : UT
Zip : 84124-4709
Country : US
Telephone Number : 801-277-8100
Fax Number : 801-277-8800
Provider Business Practice Location Address
First Line : 4505 WASATCH BLVD
Second Line : SUITE 320
City : SALT LAKE CITY
State : UT
Zip : 84124-4709
Country : US
Telephone Number : 801-277-8100
Fax Number : 801-277-8800
Authorized Official
Title or Position : LICENSED CLINICAL SOCIAL WORKER
Name : MR. STEVE VARECHOK
Credential : LCSW
Telephone Number : 801-277-8100
Provider Enumeration Date : 01/02/2007
Last Update Date : 02/26/2008

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