Organization
CANCER SURVIVOR HEALTH NETWORK, L.L.C.
Active
Other names
Survivor Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE WILLOCK (CEO)
(801) 754-6051
Entity
Organization
Contact information
Practice address
2486 EAST EMERSON AVENUE, SALT LAKE CITY, UT 84108
(801) 754-6051
(801) 210-0476
Mailing address
1338 S FOOTHILL DR # 333, SALT LAKE CITY, UT 84108-2321
(801) 754-6051
(801) 210-0476
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
174H00000X
Health Educator
—
—
2083C0008X
Clinical Informatics Physician
Primary
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QX0200X
Oncology Clinic/Center
—
—
364SX0200X
Oncology Clinical Nurse Specialist
—
—
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164852224
—
UT
Enumeration date
09/11/2017
Last updated
03/26/2025
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