NPIMap

Organization Active NPI

Lifestar Salt Lake, LLC

  • Community/Behavioral Health Agency
  • Murray, UT
National Provider Identifier
1528306446
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
123039-3501 Issued in UT
Legal business name
LIFESTAR SALT LAKE, LLC
Practice address
151 E 5600 S
#204
Murray, UT 84107-6181
Phone
(801) 262-2400
Fax
(801) 262-9991
NPI assigned
Jan 28, 2013
Last updated
Jan 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Authorized official

Name
Mr. Daniel D Gray, LCSW, CSATNPI 1336365477
Title
Clinical Director
Phone
(801) 262-2400

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 123039-3501 UT Primary

Addresses

Primary practice location

151 E 5600 S
#204
Murray, UT 84107-6181

Mailing address

151 E 5600 S
#204
Murray, UT 84107-6181
Phone (801) 262-2400

National Provider Directory

National Provider Directory
Tax ID family
Lifestar2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1528306446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 E 5600 S",
            "address_2": "#204",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841076181",
            "telephone_number": "801-262-2400",
            "fax_number": "801-262-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 E 5600 S",
            "address_2": "#204",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841076181",
            "telephone_number": "801-262-2400",
            "fax_number": "801-262-9991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTAR SALT LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "801-262-2400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW, CSAT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "UT",
            "license": "123039-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; 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.