Provider Demographics
NPI:1700957552
Name:NEIGHBORHOOD HOUSE
Entity Type:Organization
Organization Name:NEIGHBORHOOD HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-363-4589
Mailing Address - Street 1:1050 WEST 500 SO
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104
Mailing Address - Country:US
Mailing Address - Phone:801-363-4589
Mailing Address - Fax:801-363-4591
Practice Address - Street 1:423 SO 1100 WEST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104
Practice Address - Country:US
Practice Address - Phone:801-363-4593
Practice Address - Fax:801-363-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========020Medicaid
UT=========016OtherACQUIRED BRALB INJURY
UT=========002OtherAGING WAIVER