Provider Demographics
NPI:1952327546
Name:EASTERN UTAH EARLY INTERVENTION, INC.
Entity Type:Organization
Organization Name:EASTERN UTAH EARLY INTERVENTION, INC.
Other - Org Name:PRIMETIME 4 KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:435-789-5409
Mailing Address - Street 1:1360 W HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4203
Mailing Address - Country:US
Mailing Address - Phone:435-789-5409
Mailing Address - Fax:435-789-5478
Practice Address - Street 1:1360 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4203
Practice Address - Country:US
Practice Address - Phone:435-789-5409
Practice Address - Fax:435-789-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services