Provider Demographics
NPI:1750449641
Name:DIXIE WORKSHOPS INC DBA DIXIE ADVANTAGES DEVELOPMENT
Entity Type:Organization
Organization Name:DIXIE WORKSHOPS INC DBA DIXIE ADVANTAGES DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HUUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-5354
Mailing Address - Street 1:1164 N 1210 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-675-5354
Mailing Address - Fax:435-634-0923
Practice Address - Street 1:1164 N 1210 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-675-5354
Practice Address - Fax:435-634-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11777320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities