Provider Demographics
NPI:1467552208
Name:BIG BROTHERS BIG SISTERS OF UTHA
Entity Type:Organization
Organization Name:BIG BROTHERS BIG SISTERS OF UTHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:801-313-0303
Mailing Address - Street 1:151 E 5600 S
Mailing Address - Street 2:SUITE NUMBER 200
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6181
Mailing Address - Country:US
Mailing Address - Phone:801-313-0303
Mailing Address - Fax:801-313-0286
Practice Address - Street 1:151 E 5600 S
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6181
Practice Address - Country:US
Practice Address - Phone:801-313-0303
Practice Address - Fax:801-313-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder