Provider Demographics
NPI:1316004583
Name:DANVILLE SERVICES OF UTAH, LLC
Entity Type:Organization
Organization Name:DANVILLE SERVICES OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE HR DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-316-1116
Mailing Address - Street 1:7351 SO. UNION PARK AVE
Mailing Address - Street 2:#200
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-6035
Mailing Address - Country:US
Mailing Address - Phone:801-565-0700
Mailing Address - Fax:801-561-3956
Practice Address - Street 1:7351 SO. UNION PARK AVE
Practice Address - Street 2:#200
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6035
Practice Address - Country:US
Practice Address - Phone:801-565-0700
Practice Address - Fax:801-561-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320600000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10633821OtherDRIVER'S LICENSE NUMBER