Organization
CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
Active
Other names
Sacred Circle Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL CONTRERAS (BILLING MANAGER)
(801) 359-2256
Entity
Organization
Contact information
Practice address
3448 S 3200 W, WEST VALLEY, UT 84119-2628
(801) 359-2256
Mailing address
660 S 200 E STE 250, SALT LAKE CITY, UT 84111-3846
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119950086-1704
STATE LICENSE
UT
Enumeration date
03/09/2021
Last updated
03/09/2021
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