LIVE FOR LIFE CYPRESS (NPI# 1922492057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922492057 |
| Entity Type | Organization |
| Organization Name | LIVE FOR LIFE CYPRESS |
| Practice Address |
3023 N Bronzewood Cir Erda UT 84074-3302 |
| Practice Telephone | 8015774142 |
| Mailing Telephone | 8015774142 |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2019-12-23 |
| Authorized Official Name | TROY SHAW (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8015774142 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 253J00000X | Foster Care Agency | 9716 | UT | Agencies |
| Street Address |
3023 N BRONZEWOOD CIR |
| City | ERDA |
| State | UT |
| Zip Code | 84074-3302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619513363 | Atunaisa O Havili | Community Health Worker | 3023 N Bronzewood Cir, Erda, UT 84074-3302 | 2019-11-18 |
| 1881230530 | Edgar J Martinez | Community Health Worker | 3023 N Bronzewood Cir, Erda, UT 84074-3302 | 2019-11-18 |
| 1962048611 | Frank C Wolfgramm | Community Health Worker | 3023 N Bronzewood Cir, Erda, UT 84074-3302 | 2019-11-18 |
| 1720623994 | Allan L Havili | Community Health Worker | 3023 N Bronzewood Cir, Erda, UT 84074-3302 | 2019-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689233397 | Leah Elizabeth Harper I | Behavior Technician | 39 Millpond Stansbury Park, Tooele, UT 84074 | 2019-06-07 |
| 1245710789 | Tanna Marie Shelley | Community Health Worker | 27 So Main St, Tooele, UT 84074 | 2018-08-15 |
| 1528548062 | Barbara T Cederlof | Community Health Worker | 27 South Main St., Tooele, UT 84074 | 2018-08-15 |
| 1235615600 | Ashley Christine Wilson | Case Manager/Care Coordinator | 27 South Main, Tooele, UT 84074 | 2018-07-18 |
| 1174016976 | Makenzie Green | Case Manager/Care Coordinator | 27 S Main, Tooele, UT 84074 | 2018-06-07 |
| 1386151835 | Monica Lee | Physical Therapist | 6727 Ut-36 #300, Stansbury Park, UT 84074 | 2018-01-05 |
| 1871976183 | Pagnani Physical Therapy | Physical Therapist | 6727 North State Hwy 36, Suite 300, Stansbury Park, UT 84074 | 2015-07-06 |
| 1407248222 | Pebble Creek Counseling Center | Counselor | 494 E 2400 N Ste B, Tooele, UT 84074 | 2015-03-03 |
| 1528496221 | Emily Carlson | Case Manager/Care Coordinator | 220 North Millpond Rd, Suite 100, Stansbury Park, UT 84074 | 2013-10-16 |
| 1710327218 | Angela Michelle Demoss | Nurse Practitioner | 682 Country Club, Stansbury Park, UT 84074 | 2013-06-28 |
| Find all providers in zip 84074 | ||||
| Taxonomy Code | 253J00000X |
| Grouping | Agencies |
| Classification | Foster Care Agency |
| A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. |
| Notes: Source: Code Of Federal Regulations, Title 45, Volume 4, Part 1355, Section 57 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154852507 | Wade Thomson | Foster Care Agency | 1363 S State St Ste 140, Salt Lake City, UT 84115-5540 | 2017-03-27 |
| 1609274158 | Kt&t Venures | Foster Care Agency | 1140 36th St Ste 160, Ogden, UT 84403-2054 | 2014-12-16 |
| 1396157350 | Brittany Lee Coleman | Foster Care Agency | 3900 S 200 E, Suite 16, Salt Lake City, UT 84107 | 2014-05-27 |
| 1225449630 | Youthtrack, Inc | Foster Care Agency | 862 S Main Suite 4, Brigham City, UT 84302 | 2014-05-20 |
| 1093130130 | Brenda Tekell | Foster Care Agency | 862 S Main St Ste 201, Brigham City, UT 84302-3320 | 2014-02-26 |
| 1619399144 | Journey Counseling Center Salt Lake LLC | Foster Care Agency | 920 Columbia Ln, Provo, UT 84604-1320 | 2014-01-17 |
| 1568883387 | Strengthening Teens, LLC | Foster Care Agency | 165 N 1330 W Ste A1, Orem, UT 84057-5116 | 2013-12-20 |
| 1285065854 | Terie Wiederhold | Foster Care Agency | 704 N Sr 51, Spanish Fork, UT 84660-1385 | 2013-12-09 |
| 1164857892 | Journey Counseling Center Sanpete LLC | Foster Care Agency | 41 W 700 S, Ephraim, UT 84627-1524 | 2013-09-12 |
| 1427397439 | Gene Steve Lopez | Foster Care Agency | 255 Flint St, Layton, UT 84041-3616 | 2013-02-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.