Provider Demographics
NPI:1043971732
Name:SHORT CREEK SOCIAL SERVICES
Entity Type:Organization
Organization Name:SHORT CREEK SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MERIDETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-396-2454
Mailing Address - Street 1:980 W FIELD AVE # 843010
Mailing Address - Street 2:
Mailing Address - City:HILDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84784-7798
Mailing Address - Country:US
Mailing Address - Phone:480-495-5288
Mailing Address - Fax:
Practice Address - Street 1:980 W FIELD AVE # 843010
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-7798
Practice Address - Country:US
Practice Address - Phone:435-680-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
No251V00000XAgenciesVoluntary or Charitable
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No305S00000XManaged Care OrganizationsPoint of Service