Provider Demographics
NPI:1417248147
Name:SILVER LAKE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SILVER LAKE HEALTHCARE, INC.
Other - Org Name:SYMBII HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:1916 N 700 W STE 110
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5754
Mailing Address - Country:US
Mailing Address - Phone:801-444-0221
Mailing Address - Fax:801-444-2658
Practice Address - Street 1:1916 N 700 W STE 110
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5754
Practice Address - Country:US
Practice Address - Phone:801-444-0221
Practice Address - Fax:801-444-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461567Medicare Oscar/Certification