Healthcare Provider Details

I. General information

NPI: 1689828071
Provider Name (Legal Business Name): NORTHSTAR ADVOCATES AND SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 N 350 W
RICHFIELD UT
84701-1709
US

IV. Provider business mailing address

590 N 350 W
RICHFIELD UT
84701-1709
US

V. Phone/Fax

Practice location:
  • Phone: 435-201-0100
  • Fax: 435-893-8331
Mailing address:
  • Phone: 435-201-0100
  • Fax: 435-893-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CLARK THOMAS PEARSON
Title or Position: DIRECTOR
Credential:
Phone: 435-201-0100