Provider Demographics
NPI:1841404423
Name:DANVILLE SUPPORT SERVICES
Entity Type:Organization
Organization Name:DANVILLE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STROHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-363-1521
Mailing Address - Street 1:6965 UNION PARK CENTER
Mailing Address - Street 2:#330
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84098
Mailing Address - Country:US
Mailing Address - Phone:801-363-1521
Mailing Address - Fax:801-676-1510
Practice Address - Street 1:6965 UNION PARK CENTER
Practice Address - Street 2:#330
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:801-363-1521
Practice Address - Fax:801-676-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========0002Medicaid