MEDICARE: RHA COMMUNITY SERVICES OF UTAH

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	2004-SHCF-101	UT

General Provider Information

NPI Number	:	1730188459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHA COMMUNITY SERVICES OF UTAH

Provider Business Mailing Address
First Line	:	4028 S 4800 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-4537
Country	:	US
Telephone Number	:	801-968-8122
Fax Number	:	801-968-8135

Provider Business Practice Location Address
First Line	:	4028 S 4800 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-4537
Country	:	US
Telephone Number	:	801-968-8122
Fax Number	:	801-968-8135

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. CAROLE LEE HUNLEY
Credential	:
Telephone Number	:	801-968-8122

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/22/2020

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