Organization
BLACK SHIRT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON HOKE (EXECUTIVE DIRECTOR)
(385) 539-0035
Entity
Organization
Contact information
Practice address
513 S 3040 W, LEHI, UT 84043-5636
(385) 539-0035
(385) 448-5123
Mailing address
PO BOX 1008, LEHI, UT 84043-7008
(385) 539-0035
(385) 448-5123
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
102119070160
UT
Other
Enumeration date
02/07/2017
Last updated
02/07/2017
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