Healthcare Provider Details

I. General information

NPI: 1629198767
Provider Name (Legal Business Name): NORTH EASTERN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MOUNTAIN WAY DR
OREM UT
84058-5227
US

IV. Provider business mailing address

278 MOUNTAIN WAY DR
OREM UT
84058-5227
US

V. Phone/Fax

Practice location:
  • Phone: 801-802-8024
  • 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 Number4776276-0142
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: WAYNE CRABB
Title or Position: OWNER
Credential:
Phone: 801-802-8024