Provider Demographics
NPI:1225568959
Name:REDHEAD SUPPORTS-UT
Entity Type:Organization
Organization Name:REDHEAD SUPPORTS-UT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:THUESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-669-2956
Mailing Address - Street 1:929 W SUNSET BLVD STE 21-142
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4865
Mailing Address - Country:US
Mailing Address - Phone:435-669-2956
Mailing Address - Fax:
Practice Address - Street 1:929 W SUNSET BLVD STE 21-142
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4865
Practice Address - Country:US
Practice Address - Phone:435-669-2956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health