Provider Demographics
NPI:1235259797
Name:I CONNECTIONS SUPPORT COORDINATION
Entity Type:Organization
Organization Name:I CONNECTIONS SUPPORT COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SUPPORT COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:IBARGUEN
Authorized Official - Suffix:
Authorized Official - Credentials:SSW
Authorized Official - Phone:801-663-9563
Mailing Address - Street 1:1905 S 575 E
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6230
Mailing Address - Country:US
Mailing Address - Phone:801-728-0269
Mailing Address - Fax:801-728-0269
Practice Address - Street 1:1905 S 575 E
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6230
Practice Address - Country:US
Practice Address - Phone:801-728-0269
Practice Address - Fax:801-728-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1033251B00000X
UT1028251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT204638051001Medicaid
UT204638051001Medicaid