Healthcare Provider Details

I. General information

NPI: 1538486931
Provider Name (Legal Business Name): THE COVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S STATE ST
CLEARFIELD UT
84015-1818
US

IV. Provider business mailing address

PO BOX 160276
CLEARFIELD UT
84016-0276
US

V. Phone/Fax

Practice location:
  • Phone: 801-774-8675
  • Fax: 801-416-0862
Mailing address:
  • Phone: 801-774-8675
  • Fax: 801-416-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1351643501
License Number StateUT

VIII. Authorized Official

Name: MS. VERA E CHRISTENSEN
Title or Position: DIRECTOR
Credential: LCSW
Phone: 801-774-8675