| NPI | 1124242128 |
|---|---|
| Other Name | CARESOURCE SENIOR SUPPORTIVE CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | SHAWNTEL TANNER Administrator 801-266-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5221090-1205) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: UT 5221090-1205) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |