Provider Demographics
NPI:1336265420
Name:SALT LAKE COUNTY CORPORATION
Entity Type:Organization
Organization Name:SALT LAKE COUNTY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARROON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-468-2500
Mailing Address - Street 1:8446 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3568
Mailing Address - Country:US
Mailing Address - Phone:801-561-0075
Mailing Address - Fax:801-565-1205
Practice Address - Street 1:8446 HARRISON ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3568
Practice Address - Country:US
Practice Address - Phone:801-561-0075
Practice Address - Fax:801-565-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11700320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========003Medicaid