Healthcare Provider Details

I. General information

NPI: 1174469001
Provider Name (Legal Business Name): JWALKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 W 1200 N
OREM UT
84057-2606
US

IV. Provider business mailing address

67 W 1200 N
OREM UT
84057-2606
US

V. Phone/Fax

Practice location:
  • Phone: 801-427-3310
  • Fax:
Mailing address:
  • Phone: 801-427-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL M POULSEN SR.
Title or Position: OWNER
Credential:
Phone: 801-427-3310