Organization
INTERMOUNTAIN COMMUNITY SUPPORTS AND SERVICES, LLC
Active
Other names
ICSS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN SCOTT CUNNINGHAM (OWNER)
(435) 512-4045
Entity
Organization
Contact information
Practice address
5104 HERITAGE COVE, TAYLORSVILLE, UT 84129
(435) 512-4045
(801) 966-3312
Mailing address
5104 HERITAGE COVE, TAYLORSVILLE, UT 84129
(435) 512-4045
(801) 966-3312
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
UT
Other
Enumeration date
04/13/2012
Last updated
04/13/2012
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