Active NPI
Cancer Wellness House, Inc.
Doing business as Survivor Wellness
- Public Health & General Preventive Medicine Physician
- Salt Lake City, UT
National Provider Identifier
1467071407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- Legal business name
- CANCER WELLNESS HOUSE, INC.
- Doing business as
- Survivor Wellness
- Practice address
- 59 S 1100 E
Salt Lake City, UT 84102-1508 - Phone
- (801) 236-2294
- NPI assigned
- Apr 9, 2020
- Last updated
- Apr 9, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. John Librett, PHD, MPH
- Title
- Ceo
- Phone
- (801) 558-5950
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | Primary | ||
| Community/Behavioral Health Agency | 251S00000X | |||
| Voluntary or Charitable Agency | 251V00000X | |||
| Clinic/Center | 261Q00000X | |||
| Community Health Clinic/Center | 261QC1500X | |||
| Health Service Clinic/Center | 261QH0100X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | |||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X |
Addresses
Primary practice location
59 S 1100 E
Salt Lake City, UT 84102-1508
Mailing address
59 S 1100 E
Salt Lake City, UT 84102-1508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01 | Other | CLINIC/GROUP PRACTICE |
Other names 1
- Survivor Wellness
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | EHR | Direct |
National Provider Directory
National Provider DirectoryLocations
59 S 1100 E
Salt Lake City, UT 84102
Phone (801) 236-2294
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Specialist
- Sandy, UT
- NPI 1164852224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586390400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1586390400000",
"number": "1467071407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "59 S 1100 E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841021508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 S 1100 E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841021508",
"telephone_number": "801-236-2294"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CANCER WELLNESS HOUSE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2020-04-09",
"last_updated": "2020-04-09",
"certification_date": "2020-04-09",
"status": "A",
"authorized_official_last_name": "LIBRETT",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "801-558-5950",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD, MPH"
},
"taxonomies": [
{
"code": "2083P0901X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "251V00000X",
"taxonomy_group": "",
"desc": "Voluntary or Charitable",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0850X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0855X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adolescent and Children Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLINIC/GROUP PRACTICE",
"identifier": "01",
"state": null
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "EHR",
"affiliation": "N",
"endpointDescription": "Virtual internet platform",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "EHR Dashboard",
"address_1": "59 S 1100 E",
"city": "Salt Lake City",
"state": "UT",
"country_code": "US",
"postal_code": "841021508",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Survivor Wellness",
"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 Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.