Organization
WASATCH HOMELESS HEALTH CARE, INC.
Active
Other names
Fourth Street Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANIDA EMERSON (CEO)
(801) 364-0058
Entity
Organization
Contact information
Practice address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
(801) 364-0161
Mailing address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
(801) 364-0161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528128899
—
UT
01
—
201375
BLACK LUNG
UT
05
—
=========
—
UT
05
—
W0210
—
UT
Enumeration date
12/09/2006
Last updated
04/24/2025
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