Provider Demographics
NPI:1871650457
Name:WORK ACTIVITY CENTER, INC.
Entity Type:Organization
Organization Name:WORK ACTIVITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:E.
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:MCCONAUGHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-977-9779
Mailing Address - Street 1:1275 W 2320 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1448
Mailing Address - Country:US
Mailing Address - Phone:801-977-9779
Mailing Address - Fax:801-979-9791
Practice Address - Street 1:1275 W 2320 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1448
Practice Address - Country:US
Practice Address - Phone:801-977-9779
Practice Address - Fax:801-979-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11660251C00000X
UTN11008B320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========CMedicaid