1700106903 NPI number — STEPPING STONES CHILD PLACEMENT AGENCY

Table of content: (NPI 1700106903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700106903 NPI number — STEPPING STONES CHILD PLACEMENT AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPPING STONES CHILD PLACEMENT AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700106903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 E 2100 S STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84115-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-493-2100
Provider Business Mailing Address Fax Number:
801-493-2103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 E 2100 S STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84115-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-493-2100
Provider Business Practice Location Address Fax Number:
801-493-2103
Provider Enumeration Date:
06/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
JODY
Authorized Official Middle Name:
LYN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
801-493-2100

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , with the licence number:  16555 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1538488150 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710948369 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578528352 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649354127 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427376235 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881635720 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982683777 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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