Healthcare Provider Details

I. General information

NPI: 1700490067
Provider Name (Legal Business Name): OPEN ARMS YOUTH AND ADULT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 S WEST TEMPLE STE J
SALT LAKE CITY UT
84115-6701
US

IV. Provider business mailing address

3007 S WEST TEMPLE STE J
SALT LAKE CITY UT
84115-6701
US

V. Phone/Fax

Practice location:
  • Phone: 801-679-9956
  • Fax:
Mailing address:
  • Phone: 801-679-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LANGI SOFELE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 801-906-9483