Organization
UTAH ADVOCACY NETWORK
Active
Organization
UTAH ADVOCACY NETWORK
Active
Other names
Syracuse Supported Living (UAN-SSL)
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID B. ANDREASEN QIDP DIRECTOR (OWNER)
(801) 643-2866
Entity
Organization
Contact information
Practice address
2075 SOUTH BLUFF ROAD, SYRACUSE, UT 84075-9214
(801) 776-1380
(801) 784-4900
Mailing address
2075 SOUTH BLUFF ROAD, SYRACUSE, UT 84075-9214
(801) 776-1380
(801) 784-4900
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
189610-3102-20170122
UT
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5107101201
—
UT
01
—
HT007851-001
UHIN-TRADING PARTNER NUMBER
UT
Enumeration date
02/11/2015
Last updated
05/02/2017
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