Provider Demographics
NPI:1508813650
Name:NAVITAS UTAH, LLC
Entity Type:Organization
Organization Name:NAVITAS UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-865-7840
Mailing Address - Street 1:9035 WADSWORTH PKWY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8634
Mailing Address - Country:US
Mailing Address - Phone:303-865-7840
Mailing Address - Fax:303-865-7845
Practice Address - Street 1:3838 S 700 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1466
Practice Address - Country:US
Practice Address - Phone:801-590-3400
Practice Address - Fax:801-685-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVITAS CANCER REHABILITATION CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid