Provider Demographics
NPI:1801223508
Name:CONNECT2KIDS
Entity Type:Organization
Organization Name:CONNECT2KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALETA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BARELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-721-6231
Mailing Address - Street 1:883 W 4100 S
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-2685
Mailing Address - Country:US
Mailing Address - Phone:801-721-6231
Mailing Address - Fax:
Practice Address - Street 1:883 W 4100 S
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-2685
Practice Address - Country:US
Practice Address - Phone:801-721-6231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTA01958253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTA01958OtherSTATE CONTRACT
UT1790096410Medicaid