Provider Demographics
NPI:1790182814
Name:SALT LAKE HOMECARE
Entity Type:Organization
Organization Name:SALT LAKE HOMECARE
Other - Org Name:SYNERGY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-946-0355
Mailing Address - Street 1:180 E 2100 S
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2328
Mailing Address - Country:US
Mailing Address - Phone:801-556-7670
Mailing Address - Fax:
Practice Address - Street 1:180 E 2100 S
Practice Address - Street 2:SUITE #205
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2328
Practice Address - Country:US
Practice Address - Phone:801-556-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2014PCAUT000610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid