Provider Demographics
NPI:1164966008
Name:WHOLE KIDS LLC
Entity Type:Organization
Organization Name:WHOLE KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-760-4557
Mailing Address - Street 1:9947 S FUR HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4085
Mailing Address - Country:US
Mailing Address - Phone:435-760-4557
Mailing Address - Fax:
Practice Address - Street 1:9035 S 1300 E
Practice Address - Street 2:B110
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3132
Practice Address - Country:US
Practice Address - Phone:801-509-9652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty