Provider Demographics
NPI:1518083625
Name:CENTRAL UTAH CENTER FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:CENTRAL UTAH CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:CURCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-373-5044
Mailing Address - Street 1:491 N FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2824
Mailing Address - Country:US
Mailing Address - Phone:801-373-5044
Mailing Address - Fax:801-373-5094
Practice Address - Street 1:491 N FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2824
Practice Address - Country:US
Practice Address - Phone:801-373-5044
Practice Address - Fax:801-373-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0177251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0177Medicaid