Organization
FRIENDS FOR LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY SHUPE (OWNER/MANAGER)
(801) 710-0210
Entity
Organization
Contact information
Practice address
2228 S 2325 W, SYRACUSE, UT 84075-9282
(801) 710-0210
Mailing address
2228 S 2325 W, SYRACUSE, UT 84075-9282
(801) 710-0210
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/29/2008
Last updated
10/29/2008
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