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Organization

EXTENDED FAMILY BOYS, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERIE WIEDERHOLD PH.D (ADMINISTRATIVE DIRECTOR)
(801) 794-0318
Entity
Organization

Contact information

Practice address
704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
(801) 794-9514
Mailing address
704 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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