Provider Demographics
NPI:1225283666
Name:SOMALI BANTU ASSOCIATION OF UTAH
Entity Type:Organization
Organization Name:SOMALI BANTU ASSOCIATION OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-309-8488
Mailing Address - Street 1:1133 ARAPAHOE AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-2423
Mailing Address - Country:US
Mailing Address - Phone:585-309-8488
Mailing Address - Fax:
Practice Address - Street 1:1133 ARAPAHOE AVE
Practice Address - Street 2:APT. A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-2423
Practice Address - Country:US
Practice Address - Phone:585-309-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management