Healthcare Provider Details

I. General information

NPI: 1205646908
Provider Name (Legal Business Name): VENTURE CROSSING LLC DRAPER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12894 S PONY EXPRESS RD
DRAPER UT
84020-8328
US

IV. Provider business mailing address

3192 W 2450 N
LEHI UT
84043-6060
US

V. Phone/Fax

Practice location:
  • Phone: 202-421-9166
  • Fax:
Mailing address:
  • Phone: 202-421-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: COREY ASTILL
Title or Position: CEO
Credential:
Phone: 202-421-9166