| NPI | 1609315431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLYN TEED Administrator 435-256-0867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251T00000X PACE Provider Organization (Licence: UT 2016-PCA-UT000780) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: UT 2016-PCA-UT000780) |
| 385H00000X Respite Care (Licence: UT 2016-PCA-UT000780) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-05-08 |