Healthcare Provider Details

I. General information

NPI: 1194910133
Provider Name (Legal Business Name): CEFIA ENTERPRISES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E SCENIC PEAK CV
DRAPER UT
84020-9222
US

IV. Provider business mailing address

PO BOX 9034
CHANDLER HEIGHTS AZ
85127-9034
US

V. Phone/Fax

Practice location:
  • Phone: 801-282-6953
  • Fax: 801-855-7215
Mailing address:
  • Phone: 702-743-1269
  • Fax: 801-855-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberGF1254016640001
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number19995
License Number StateUT

VIII. Authorized Official

Name: MR. CEDRIC DELEON PITTMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: MPA
Phone: 801-282-6953