Provider Demographics
NPI:1124021050
Name:PAPPADAKIS ENTERPRISES
Entity Type:Organization
Organization Name:PAPPADAKIS ENTERPRISES
Other - Org Name:MIDTOWN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PAPPADAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:801-363-6340
Mailing Address - Street 1:125 S 900 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-1125
Mailing Address - Country:US
Mailing Address - Phone:801-363-6340
Mailing Address - Fax:801-359-8533
Practice Address - Street 1:125 S 900 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-1125
Practice Address - Country:US
Practice Address - Phone:801-363-6340
Practice Address - Fax:801-359-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-NCF-368314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT990177673001Medicaid
UT990177673001Medicaid