Provider Demographics
NPI:1063456143
Name:UNI HOME PROJECT PSYCHIATRIC
Entity Type:Organization
Organization Name:UNI HOME PROJECT PSYCHIATRIC
Other - Org Name:NEUROBEHAVIOR HOME PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:801-587-3108
Mailing Address - Street 1:PO BOX 413076
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3076
Mailing Address - Country:US
Mailing Address - Phone:801-239-3900
Mailing Address - Fax:801-587-6459
Practice Address - Street 1:650 KOMAS DRIVE, STE. #200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-585-1933
Practice Address - Fax:801-581-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055955Medicare PIN