1033118674 NPI number — RHA COMMUNITY SERVICES OF UTAH

Table of content: (NPI 1033118674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033118674 NPI number — RHA COMMUNITY SERVICES OF UTAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHA COMMUNITY SERVICES OF UTAH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH SIDE CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033118674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1233
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-292-6797
Provider Business Mailing Address Fax Number:
801-295-3660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 N 100 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-6054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-292-6797
Provider Business Practice Location Address Fax Number:
801-295-3660
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CONOVER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
801-292-6797

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  2005-SHCF-344 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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