Healthcare Provider Details

I. General information

NPI: 1497687396
Provider Name (Legal Business Name): J WALKER HOUSE 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E 1200 N
OREM UT
84057-2712
US

IV. Provider business mailing address

358 E 1200 N
OREM UT
84057-2712
US

V. Phone/Fax

Practice location:
  • Phone: 435-319-0351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GREYDEN HEDBERG
Title or Position: BILLING MANAGER
Credential:
Phone: 435-319-0351