Healthcare Provider Details

I. General information

NPI: 1790337772
Provider Name (Legal Business Name): NORTHERN UTAH CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 W RAMOLA ST
KAYSVILLE UT
84037-9416
US

IV. Provider business mailing address

PO BOX 983
KAYSVILLE UT
84037-0983
US

V. Phone/Fax

Practice location:
  • Phone: 801-309-3526
  • Fax:
Mailing address:
  • Phone: 801-309-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY ANN NEF
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: S.S.W.
Phone: 801-309-3526