Provider Demographics
NPI:1376939371
Name:NEUROBEHAVIOR HOME PROGRAM
Entity type:Organization
Organization Name:NEUROBEHAVIOR HOME PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-587-3109
Mailing Address - Street 1:650 S KOMAS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1215
Mailing Address - Country:US
Mailing Address - Phone:801-581-5515
Mailing Address - Fax:
Practice Address - Street 1:650 S KOMAS DR
Practice Address - Street 2:STE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-581-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health