Healthcare Provider Details

I. General information

NPI: 1548112386
Provider Name (Legal Business Name): SACRED SPACES SUPPORTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7296 W SENTINAL RD
WEST VALLEY CITY UT
84081-6072
US

IV. Provider business mailing address

7296 W SENTINAL RD
WEST VALLEY CITY UT
84081-6072
US

V. Phone/Fax

Practice location:
  • Phone: 801-815-6905
  • Fax:
Mailing address:
  • Phone: 801-815-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDRA MICIC
Title or Position: OWNER
Credential: LCSW
Phone: 801-815-6905