OrganizationActive
Extended Family, Inc.
NPI 1215068267 · Emotionally Disturbed Childrens' Residential Treatment Facility · Spanish Fork, UT
Provider details
- NPI number
- 1215068267
- Entity type
- Organization
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Paul Wiederhold, Executive Director(801) 794-0318
- License
- 12040 (UT)
Specialties & taxonomies
Residential Treatment Facilities
Practice location
704 N State Road 51
Spanish Fork, UT 84660-1385
Phone: (801) 794-0318
Fax: (801) 794-9514
Approximate (ZIP-level) locationGet directions
Mailing address
704 N State Road 51
Spanish Fork, UT 84660-1385
Registry dates
- Enumerated
- 2007-03-08
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.