Provider Demographics
NPI:1417268673
Name:ENSIGN PEAK SERVICES, INC.
Entity Type:Organization
Organization Name:ENSIGN PEAK SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-982-1404
Mailing Address - Street 1:2880 W 4700 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-2156
Mailing Address - Country:US
Mailing Address - Phone:801-982-1404
Mailing Address - Fax:801-982-1365
Practice Address - Street 1:2880 W 4700 S
Practice Address - Street 2:SUITE B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-2156
Practice Address - Country:US
Practice Address - Phone:801-982-1404
Practice Address - Fax:801-982-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15609-10253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency