Organization
CARESOURCE
Active
Other names
CareSource Rehab and Supportive Care
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNTEL TANNER MA, SSW (CEO)
(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
314000000X
Skilled Nursing Facility
Primary
2016-NCF-UT000747
UT
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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