Healthcare Provider Details

I. General information

NPI: 1598076598
Provider Name (Legal Business Name): CHILD & FAMILY EMPOWERMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 W 1700 S STE 103
SALT LAKE CITY UT
84104-3490
US

IV. Provider business mailing address

1578 W 1700 S STE 103
SALT LAKE CITY UT
84104-3490
US

V. Phone/Fax

Practice location:
  • Phone: 801-972-2711
  • Fax:
Mailing address:
  • Phone: 801-972-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1332463501
License Number StateUT

VIII. Authorized Official

Name: MS. LANI TAHOLO
Title or Position: DIRECTOR
Credential: L.C.S.W.
Phone: 801-972-2711