Provider Demographics
NPI:1942379748
Name:OPTIONS FOR INDEPENDENCE
Entity Type:Organization
Organization Name:OPTIONS FOR INDEPENDENCE
Other - Org Name:NORTHERN UTAH CENTER FOR INDEPENDENT LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:NFT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:435-753-5353
Mailing Address - Street 1:1095 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2215
Mailing Address - Country:US
Mailing Address - Phone:435-753-5353
Mailing Address - Fax:435-753-5390
Practice Address - Street 1:1095 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2215
Practice Address - Country:US
Practice Address - Phone:435-753-5353
Practice Address - Fax:435-753-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid