Provider Demographics
NPI:1144673013
Name:NEIGHBORHOOD HOUSE
Entity type:Organization
Organization Name:NEIGHBORHOOD HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTTALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-363-4589
Mailing Address - Street 1:1050 W 500 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-1319
Mailing Address - Country:US
Mailing Address - Phone:801-363-4589
Mailing Address - Fax:801-363-4591
Practice Address - Street 1:423 SOUTH 1100 WEST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104
Practice Address - Country:US
Practice Address - Phone:801-363-4593
Practice Address - Fax:801-363-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3587864002261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT320Medicaid