Provider Demographics
NPI:1780182683
Name:VALLEYFIT CLINIC LLC
Entity type:Organization
Organization Name:VALLEYFIT CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-949-4864
Mailing Address - Street 1:4460 S HIGHLAND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3562
Mailing Address - Country:US
Mailing Address - Phone:801-273-6580
Mailing Address - Fax:801-263-7203
Practice Address - Street 1:4460 S HIGHLAND DR STE 300
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3562
Practice Address - Country:US
Practice Address - Phone:801-273-6580
Practice Address - Fax:801-263-7203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY MENTAL HEALTH INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50600A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherIRS