# CARESOURCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CareSource Senior Supportive Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124242128
- **Authorized official:** MRS. SHAWNTEL TANNER MA (ADMINISTRATOR)
- **Authorized official phone:** (801) 266-7200

## Contact information

- **Practice address:** 1624 E 4500 S, SALT LAKE CITY, UT 84117-4212
- **Practice address phone:** (801) 266-7200
- **Practice address fax:** (801) 266-7004
- **Mailing address:** 1624 E 4500 S, SALT LAKE CITY, UT 84117-4212
- **Mailing address phone:** (801) 266-7200
- **Mailing address fax:** (801) 266-7004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 5221090-1205 | UT | — |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | 5221090-1205 | UT | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 09/11/2025