Provider Demographics
NPI:1326336447
Name:THE FAMILY PLACE UTAH
Entity Type:Organization
Organization Name:THE FAMILY PLACE UTAH
Other - Org Name:THE FAMILY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ERS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-932-6275
Mailing Address - Street 1:PO BOX 6055
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6055
Mailing Address - Country:US
Mailing Address - Phone:435-752-8880
Mailing Address - Fax:435-752-8884
Practice Address - Street 1:1525 N 200 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-752-8880
Practice Address - Fax:435-752-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52887251S00000X
UT17942320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness