Healthcare Provider Details

I. General information

NPI: 1114831757
Provider Name (Legal Business Name): POPPYS PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 W 300 S
PROVO UT
84601-4369
US

IV. Provider business mailing address

244 W 300 S STE 1
PROVO UT
84601-4369
US

V. Phone/Fax

Practice location:
  • Phone: 385-224-2798
  • Fax:
Mailing address:
  • Phone: 385-224-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACOB RAWLINS
Title or Position: OWNER
Credential:
Phone: 385-224-2798