Organization
CARESOURCE LLC
Active
Organization
CARESOURCE LLC
Active
Other names
CareSource Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWNTEL TANNER MA (ADMINISTRATOR)
(801) 266-7200
Entity
Organization
Contact information
Practice address
1624 E 4500 S, SALT LAKE CITY, UT 84117-4212
(801) 266-7200
(801) 266-7004
Mailing address
1624 E 4500 S, SALT LAKE CITY, UT 84117-4212
(801) 266-7200
(801) 266-7004
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
2006-HOSPICE-30731
UT
Other
Enumeration date
04/12/2007
Last updated
03/16/2012
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