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NPI Code Detail

MEDICARE: SALT LAKE BEHAVIORAL HEALTH, LLC

MEDICARE: SALT LAKE BEHAVIORAL HEALTH, LLC
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
1283Q00000XPsychiatric Hospital2013-HOSP-98106UT

General Provider Information

NPI Number : 1811317373
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALT LAKE BEHAVIORAL HEALTH, LLC
Provider Business Mailing Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6035
Fax Number : 801-264-6070
Provider Business Practice Location Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6000
Fax Number : 801-264-6070
Authorized Official
Title or Position : ADMINISTRATIVE ASSISTANT
Name : MR. GREG G WINN
Credential :
Telephone Number : 801-264-6035
Provider Enumeration Date : 04/23/2014
Last Update Date : 04/23/2014

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