MEDICARE: JORDAN VALLEY DAY CARE AND TRAINING CENTER LAY BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		UT

General Provider Information

NPI Number	:	1932256906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN VALLEY DAY CARE AND TRAINING CENTER LAY BOARD

Provider Business Mailing Address
First Line	:	2120 E 3900 S
Second Line	:	201
City	:	HOLLADAY
State	:	UT
Zip	:	84124-1771
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 E 3900 S
Second Line	:	201
City	:	HOLLADAY
State	:	UT
Zip	:	84124-1771
Country	:	US
Telephone Number	:	801-274-2919
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DAWN RUSSELL
Credential	:
Telephone Number	:	801-274-2919

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/21/2022

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