1568424828 NPI number — CHILD & FAMILY EMPOWERMENT SERVICES, LLC

Table of content: (NPI 1568424828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568424828 NPI number — CHILD & FAMILY EMPOWERMENT SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILD & FAMILY EMPOWERMENT SERVICES, LLC
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:
1568424828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1578 W 1700 S
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84104-3470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-972-2711
Provider Business Mailing Address Fax Number:
801-972-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1578 W 1700 S
Provider Second Line Business Practice Location Address:
SUITE #200
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:
84104-3470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-972-2711
Provider Business Practice Location Address Fax Number:
801-972-2709
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAHOLO
Authorized Official First Name:
LEILANI
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
801-972-2711

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  136834-3501 , 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: 788007788049 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com