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General NPI Number Information
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NPI Number | 1285033977
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Entity Type | Organization
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Legal Business Name | UTAH FAMILY CARE LLC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 3575 S 3200 W APT 6C
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3571
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Country | US
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Telephone | 801-921-1626
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 S 3200 W APT 6C
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3571
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Country | US
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Telephone | 801-921-1626
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARIA LAVEKIHELOTU
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Credential |
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Telephone | 801-921-1626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 13W82711
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License Number State | UT
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