Provider Demographics
NPI:1184312795
Name:FOUNDATION FOR FAMILY LIFE
Entity type:Organization
Organization Name:FOUNDATION FOR FAMILY LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-750-5398
Mailing Address - Street 1:11978 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7403
Mailing Address - Country:US
Mailing Address - Phone:801-839-4384
Mailing Address - Fax:801-747-6858
Practice Address - Street 1:11978 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7403
Practice Address - Country:US
Practice Address - Phone:801-839-4384
Practice Address - Fax:801-747-6858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATION FOR FAMILY LIFE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty