Provider Demographics
NPI:1477658854
Name:UINTAH ADULT DAY CENTER
Entity Type:Organization
Organization Name:UINTAH ADULT DAY CENTER
Other - Org Name:UINTAH ADULT ACTIVITY AW
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-781-3500
Mailing Address - Street 1:510 S 500 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4301
Mailing Address - Country:US
Mailing Address - Phone:435-781-3500
Mailing Address - Fax:435-789-3201
Practice Address - Street 1:510 S 500 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4301
Practice Address - Country:US
Practice Address - Phone:435-781-3500
Practice Address - Fax:435-789-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9873261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519160002004Medicaid
UT519160002004Medicaid
UT870401162004Medicare UPIN