Provider Demographics
NPI:1164579355
Name:COUNTY OF SALT LAKE
Entity Type:Organization
Organization Name:COUNTY OF SALT LAKE
Other - Org Name:SALT LAKE COUNTY CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-468-2766
Mailing Address - Street 1:2001 S STATE ST
Mailing Address - Street 2:S1500
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84190-2300
Mailing Address - Country:US
Mailing Address - Phone:801-468-2454
Mailing Address - Fax:801-468-2852
Practice Address - Street 1:1992 S 200 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2459
Practice Address - Country:US
Practice Address - Phone:801-468-2454
Practice Address - Fax:801-468-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 332B00000X, 332U00000X
UT346865-3102251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064172OtherMEDICARE PTAN
1164579335OtherNATIONAL PROVIDER IDENTIF
UT000064172OtherMEDICARE PTAN
UT=========057Medicaid