Provider Demographics
NPI:1295929149
Name:LIZ HALE, PH.D.
Entity type:Organization
Organization Name:LIZ HALE, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-328-2164
Mailing Address - Street 1:702 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE B-20
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1204
Mailing Address - Country:US
Mailing Address - Phone:801-363-2245
Mailing Address - Fax:
Practice Address - Street 1:702 E SOUTH TEMPLE
Practice Address - Street 2:SUITE B-20
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-1204
Practice Address - Country:US
Practice Address - Phone:801-363-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5234322-2501310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility