Provider Demographics
NPI:1548530611
Name:TRI-COUNTY INDEPENDENT LIVING CENTER OF UTAH
Entity type:Organization
Organization Name:TRI-COUNTY INDEPENDENT LIVING CENTER OF UTAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-612-3215
Mailing Address - Street 1:2726 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3677
Mailing Address - Country:US
Mailing Address - Phone:801-612-3215
Mailing Address - Fax:801-612-3732
Practice Address - Street 1:2726 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3677
Practice Address - Country:US
Practice Address - Phone:801-612-3215
Practice Address - Fax:801-612-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable