Provider Demographics
NPI:1619367265
Name:SALT LAKE COUNTY AGING & ADULT SERVICES
Entity Type:Organization
Organization Name:SALT LAKE COUNTY AGING & ADULT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE & FISCAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-468-3183
Mailing Address - Street 1:2001 S STATE ST
Mailing Address - Street 2:S1 600
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84190-0001
Mailing Address - Country:US
Mailing Address - Phone:385-468-3210
Mailing Address - Fax:385-468-3186
Practice Address - Street 1:2001 S STATE ST
Practice Address - Street 2:S1 600
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84190-0001
Practice Address - Country:US
Practice Address - Phone:385-468-3210
Practice Address - Fax:385-468-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management