Provider Demographics
NPI:1063062164
Name:STATE OF UTAH, DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:STATE OF UTAH, DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYKIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SARACINO
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:385-228-4798
Mailing Address - Street 1:PO BOX 144720
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84114-4720
Mailing Address - Country:US
Mailing Address - Phone:801-584-8226
Mailing Address - Fax:
Practice Address - Street 1:2540 WASHINGTON BLVD STE 122
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3112
Practice Address - Country:US
Practice Address - Phone:801-626-0256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency