Healthcare Provider Details

I. General information

NPI: 1932256906
Provider Name (Legal Business Name): JORDAN VALLEY DAY CARE AND TRAINING CENTER LAY BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 E 3900 S 201
HOLLADAY UT
84124-1771
US

IV. Provider business mailing address

2120 E 3900 S 201
HOLLADAY UT
84124-1771
US

V. Phone/Fax

Practice location:
  • Phone: 801-274-2919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. DAWN RUSSELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-274-2919