Organization
ASPIRE RIVERDALE BROOKHAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE KINIKINI (PRESIDENT)
(801) 628-5577
Entity
Organization
Contact information
Practice address
4933 S 1500 W STE 200, RIVERDALE, UT 84405-7738
(801) 525-4645
(801) 779-7808
Mailing address
4933 S 1500 W STE 200, RIVERDALE, UT 84405-7738
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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