Provider Demographics
NPI:1407536766
Name:1 SOURCE 211 SERVICES
Entity Type:Organization
Organization Name:1 SOURCE 211 SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC SERVICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAUNDRIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADVOCATE/ CNA
Authorized Official - Phone:702-462-0067
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-0633
Mailing Address - Country:US
Mailing Address - Phone:702-462-0067
Mailing Address - Fax:
Practice Address - Street 1:955 E 200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2432
Practice Address - Country:US
Practice Address - Phone:702-462-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty