Organization
EXTENDED FAMILY GIRLS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL WIEDERHOLD PH.D (EXECUTIVE DIRECTOR)
(801) 794-0318
Entity
Organization
Contact information
Practice address
706 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
(801) 794-9514
Mailing address
706 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
(801) 794-9514
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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