Healthcare Provider Details

I. General information

NPI: 1548573850
Provider Name (Legal Business Name): MANA TRAINING CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9176 S 300 W SUITE 34
SANDY UT
84070-2668
US

IV. Provider business mailing address

9176 S 300 W SUITE 34
SANDY UT
84070-2668
US

V. Phone/Fax

Practice location:
  • Phone: 801-347-2539
  • Fax: 801-341-8345
Mailing address:
  • Phone: 801-347-2539
  • Fax: 801-341-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number16596
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number16596
License Number StateUT

VIII. Authorized Official

Name: MR. SAMUEL FILIKITONGA BROWN
Title or Position: PROGRAM DIRECTOR
Credential: MSW
Phone: 801-347-2539