Provider Demographics
NPI:1629651013
Name:EXTEND YOUR OHANA LLC
Entity Type:Organization
Organization Name:EXTEND YOUR OHANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATJA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-879-6058
Mailing Address - Street 1:4892 S TEAL RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4892 S TEAL RIVER WAY
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-4362
Practice Address - Country:US
Practice Address - Phone:801-879-6058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency