CareSource Senior Supportive Care Center – Hospice and Palliative Medicine (Family Medicine) Physician, NPI 1124242128

CareSource Senior Supportive Care Center is a healthcare provider. based in Salt lake city, Utah. specializing in Hospice and Palliative Medicine (Family Medicine) Physician. The organization holds a License No. 5221090-1205 (UT). The NPI Number for CareSource Senior Supportive Care Center is 1124242128

Main info

Organization
Name
CareSource Senior Supportive Care Center
NPI
1124242128
Phone
(801) 266-7200
Address
1624 E 4500 S
Authorized Official
MRS. SHAWNTEL TANNER ADMINISTRATOR MA
Enumeration Date
12 April 2007
Last Update Date
11 September 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness90
Years active:19State licenses:1Digital endpoints

Provider Addresses for CareSource Senior Supportive Care Center

  • 1624 E 4500 S

    SALT LAKE CITY, UT 841174212

    Phone: (801) 266-7200

    Fax: (801) 266-7004

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84117)

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Frequently asked questions

Where can patients find CareSource Senior Supportive Care Center's NPI?
You can confirm CareSource Senior Supportive Care Center with NPI 1124242128; it appears in the national provider directory.
Is CareSource Senior Supportive Care Center's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is CareSource Senior Supportive Care Center?
The page reflects Hospice and Palliative Medicine (Family Medicine) Physician for CareSource Senior Supportive Care Center. Clinical services aligned with this taxonomy classification.
Where does public data place CareSource Senior Supportive Care Center?
The snapshot lists Salt Lake City, Utah for CareSource Senior Supportive Care Center; download NPPES for the complete set.
Is this NPI for an individual or an organization?
This listing corresponds to an Organization.

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