Provider Demographics
NPI:1255533238
Name:CONTI-CARE, LLC
Entity type:Organization
Organization Name:CONTI-CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APRN
Authorized Official - Phone:801-361-6038
Mailing Address - Street 1:1495 N 200 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2626
Mailing Address - Country:US
Mailing Address - Phone:801-361-6038
Mailing Address - Fax:801-764-9393
Practice Address - Street 1:1495 N 200 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2626
Practice Address - Country:US
Practice Address - Phone:801-361-6038
Practice Address - Fax:801-764-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT213838-4405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529967696002Medicaid
UT21383844001001OtherBXBS
UT529967696002Medicaid