Provider Demographics
NPI:1922710383
Name:SOUTH VALLEY SANCTUARY
Entity Type:Organization
Organization Name:SOUTH VALLEY SANCTUARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:435-705-4625
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-7028
Mailing Address - Country:US
Mailing Address - Phone:801-255-1095
Mailing Address - Fax:
Practice Address - Street 1:324 E 10TH AVE STE 280
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2875
Practice Address - Country:US
Practice Address - Phone:801-255-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty