Basic Information
| Provider Information | |||||||||
| NPI: | 1609838911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMISE HOSPITAL OF SALT LAKE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO ROAD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 5618260171 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 TH AVE C ST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841430001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014087120 | ||||||||
| FaxNumber: | 8014087113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOPWOOD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5618693100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 2004-HOSP-42993 | UT | Y | Hospitals | Long Term Care Hospital |
No ID Information.