NPIMap

Organization Active NPI

Caresource

Doing business as CareSource Rehab and Supportive Care

  • Skilled Nursing Facility
  • Salt Lake City, UT
National Provider Identifier
1316490402
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2016-NCF-UT000747 Issued in UT
Legal business name
CARESOURCE
Doing business as
CareSource Rehab and Supportive Care
Practice address
1624 E 4500 S
Salt Lake City, UT 84117-4212
Phone
(801) 266-7200
Fax
(801) 266-7004
NPI assigned
Jul 26, 2016
Last updated
Jul 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawntel Tanner, MA, SSW
Title
Ceo
Phone
(801) 266-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2016-NCF-UT000747 UT Primary

Addresses

Primary practice location

1624 E 4500 S
Salt Lake City, UT 84117-4212

Mailing address

1624 E 4500 S
Salt Lake City, UT 84117-4212
Phone (801) 266-7200

Other names 1

  • CareSource Rehab and Supportive Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Caresource3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1316490402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 E 4500 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174212",
            "telephone_number": "801-266-7200",
            "fax_number": "801-266-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 E 4500 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174212",
            "telephone_number": "801-266-7200",
            "fax_number": "801-266-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "SHAWNTEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-266-7200",
        "authorized_official_credential": "MA, SSW"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": "2016-NCF-UT000747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CareSource Rehab and Supportive Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.