Provider Demographics
NPI:1750334645
Name:CAREGIVER SUPPORT NETWORK, INC
Entity type:Organization
Organization Name:CAREGIVER SUPPORT NETWORK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:801-747-2100
Mailing Address - Street 1:404 E 4500 S STE A24
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2756
Mailing Address - Country:US
Mailing Address - Phone:801-747-2100
Mailing Address - Fax:801-747-2104
Practice Address - Street 1:404 E 4500 S STE A24
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2756
Practice Address - Country:US
Practice Address - Phone:801-747-2100
Practice Address - Fax:801-747-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========003Medicaid
UT=========003MedicaidDAVIS MEDICAID WAIVER
UT=========003MedicaidDAVIS MEDICAID WAIVER
UT461564Medicare ID - Type UnspecifiedHOSPICE PROVIDER #