Provider Demographics
NPI:1235481763
Name:MULBERRY HOLLOW COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MULBERRY HOLLOW COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-671-8407
Mailing Address - Street 1:2885 E CHERRY BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4607
Mailing Address - Country:US
Mailing Address - Phone:801-671-8407
Mailing Address - Fax:
Practice Address - Street 1:2885 E CHERRY BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4607
Practice Address - Country:US
Practice Address - Phone:801-671-8407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage