Provider Demographics
NPI:1649523572
Name:SACRED CIRCLE HEALTH CARE
Entity type:Organization
Organization Name:SACRED CIRCLE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-669-1607
Mailing Address - Street 1:660 S 200 E
Mailing Address - Street 2:#250
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3835
Mailing Address - Country:US
Mailing Address - Phone:801-359-2256
Mailing Address - Fax:801-364-4392
Practice Address - Street 1:660 S 200 E
Practice Address - Street 2:#250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3835
Practice Address - Country:US
Practice Address - Phone:801-359-2256
Practice Address - Fax:801-364-4392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONFEDERATED TRIBE OF THE GOSHUTES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-16
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201203834261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center