Healthcare Provider Details

I. General information

NPI: 1326336447
Provider Name (Legal Business Name): THE FAMILY PLACE UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N 200 W
LOGAN UT
84341
US

IV. Provider business mailing address

PO BOX 6055
LOGAN UT
84341-6055
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-8880
  • Fax: 435-752-8884
Mailing address:
  • Phone: 435-752-8880
  • Fax: 435-752-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number52887
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number17942
License Number StateUT

VIII. Authorized Official

Name: LAURA JANE SEAGER
Title or Position: ERS
Credential:
Phone: 435-932-6275