Organization
EXTENDED FAMILY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERIE WIEDERHOLD (ADMINISTRATIVE DIRECTOR)
(801) 794-0318
Entity
Organization
Contact information
Practice address
704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
Mailing address
704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
21187
UT
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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