Provider Demographics
NPI:1083610869
Name:CAREGIVER SUPPORT NETWORK, INC
Entity Type:Organization
Organization Name:CAREGIVER SUPPORT NETWORK, INC
Other - Org Name:CAREGIVER SUPPORT NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:801-747-2100
Mailing Address - Street 1:404 E 4500 S STE A24
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2756
Mailing Address - Country:US
Mailing Address - Phone:801-747-2100
Mailing Address - Fax:801-747-2104
Practice Address - Street 1:404 E 4500 S STE A24
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2756
Practice Address - Country:US
Practice Address - Phone:801-747-2100
Practice Address - Fax:801-747-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-25
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-HHA-20903251E00000X
UT363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid
UT=========-005Medicaid
UT=========-004Medicaid
UT=========001Medicaid
UT=========001MedicaidMEDICAID
UT=========-003Medicaid
UT=========011Medicaid
UT=========-003Medicaid