Provider Demographics
NPI:1245230820
Name:RHA COMMUNITY SERVICES OF UTAH
Entity Type:Organization
Organization Name:RHA COMMUNITY SERVICES OF UTAH
Other - Org Name:BUNGALOW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKLYNN
Authorized Official - Middle Name:IVY
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-582-8097
Mailing Address - Street 1:645 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3206
Mailing Address - Country:US
Mailing Address - Phone:801-582-1457
Mailing Address - Fax:801-582-3901
Practice Address - Street 1:645 S 1300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3206
Practice Address - Country:US
Practice Address - Phone:801-582-1457
Practice Address - Fax:801-582-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-NCF-22315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========048Medicaid