Provider Demographics
NPI:1407949357
Name:CATHOLIC COMMUNITY SERVICES OF UTAH
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. CLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-977-9119
Mailing Address - Street 1:250 E BROADWAY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2418
Mailing Address - Country:US
Mailing Address - Phone:801-977-9119
Mailing Address - Fax:801-977-8227
Practice Address - Street 1:250 E BROADWAY
Practice Address - Street 2:SUITE 380
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84111-2418
Practice Address - Country:US
Practice Address - Phone:801-977-9119
Practice Address - Fax:801-977-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTN10601261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder