1992310593 NPI number — JUST THE RIGHT AGE

Table of content: (NPI 1992310593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992310593 NPI number — JUST THE RIGHT AGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUST THE RIGHT AGE
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:
1992310593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7535 S UNION PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDVALE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84047-3043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-564-7091
Provider Business Mailing Address Fax Number:
877-595-1086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7535 S UNION PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDVALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84047-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-564-7091
Provider Business Practice Location Address Fax Number:
877-595-1086
Provider Enumeration Date:
09/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HASTIE
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-564-7091

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 204722-4405 . This is a "UTAH DEPARTMENT OF PROFESSIONAL LICENSING" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com