Healthcare Provider Details

I. General information

NPI: 1053020768
Provider Name (Legal Business Name): RESOURCE INITIATIVE FOR COMMUNITY EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N 1125 W
OREM UT
84057-2882
US

IV. Provider business mailing address

1141 N 1125 W
OREM UT
84057-2882
US

V. Phone/Fax

Practice location:
  • Phone: 801-921-1766
  • Fax:
Mailing address:
  • Phone: 801-921-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PEDRO L PEREZ AQUINO
Title or Position: CEO
Credential:
Phone: 801-921-1766