Extended Family

NPI #1285065607 in Spanish Fork, Utah

Provider Information

NPI Number: 1285065607
Entity Type: Organization
Organization Name: Extended Family
Primary Specialty: Foster Care Agency
Enumeration Date: Dec 11, 2013
Last Updated: Dec 11, 2013

Practice Location

Address: 704 N STATE ROAD 51
City: Spanish Fork
State: Utah
ZIP Code: 84660-1385
Phone: (801) 794-0318

Authorized Official

Name: TERIE WIEDERHOLD
Title: ADMINISTRATIVE DIRECTOR
Phone: (801) 794-0318

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Foster Care Agency	253J00000X	Primary

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