Provider Demographics
NPI:1932256906
Name:JORDAN VALLEY DAY CARE AND TRAINING CENTER LAY BOARD
Entity Type:Organization
Organization Name:JORDAN VALLEY DAY CARE AND TRAINING CENTER LAY BOARD
Other - Org Name:JORDAN VALLEY SUPPORTED EMPLOYMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-274-2919
Mailing Address - Street 1:2120 E 3900 S
Mailing Address - Street 2:201
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2120 E 3900 S
Practice Address - Street 2:201
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-1771
Practice Address - Country:US
Practice Address - Phone:801-274-2919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services