Provider Demographics
NPI:1245095710
Name:FIRST WATCH WELLNESS, LLC
Entity type:Organization
Organization Name:FIRST WATCH WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-707-8282
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1008
Mailing Address - Country:US
Mailing Address - Phone:877-225-5443
Mailing Address - Fax:
Practice Address - Street 1:13867 S BANGERTER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5318
Practice Address - Country:US
Practice Address - Phone:877-225-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty