Organization
WEST JORDAN CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M. KELSO (PRESIDENT)
(801) 389-1523
Entity
Organization
Contact information
Practice address
3350 W 7800 S, WEST JORDAN, UT 84088-4506
(801) 282-0686
(801) 282-9767
Mailing address
5007 S MISSION DR, SAINT JOSEPH, MO 64505-9404
(816) 232-9573
(816) 232-9596
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2004-NCF-470
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
742561471031
—
UT
Enumeration date
12/27/2005
Last updated
08/22/2020
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