Organization
RED MESA HOUSING CASE MANAGEMENT
Active
Parent organization
URBAN INDIAN CENTER OF SALT LAKE
Organization subpart
Yes
Provider details
NPI number
Legal business name
URBAN INDIAN CENTER OF SALT LAKE
Authorized official
DR. PAUL S FLACK DMFT, LMFT (ACTING EXECUTIVE DIRECTOR)
(801) 214-7681
Entity
Organization
Contact information
Practice address
580 S 500 W, SALT LAKE CITY, UT 84101-2209
(801) 746-6852
(801) 746-7687
Mailing address
120 W 1300 S, SALT LAKE CITY, UT 84115-5230
(801) 214-7681
(801) 214-7685
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11544773158
—
UT
Enumeration date
03/28/2019
Last updated
03/28/2019
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