Organization
EMPOWERED FOR LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA CASALLO (PRESIDENT)
(801) 244-6599
Entity
Organization
Contact information
Practice address
5004 WEST JANETTE DRIVE, WEST VALLEY CITY, UT 84120
(801) 244-6599
(801) 969-7105
Mailing address
1467 RIVERSIDE DR, SALT LAKE CITY, UT 84104-2116
(801) 244-6599
(801) 969-7105
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
20071054
UT
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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