Provider Demographics
NPI:1902118771
Name:GOAL HOME LLC
Entity Type:Organization
Organization Name:GOAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OVIATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-808-5826
Mailing Address - Street 1:2785 W 9000 S # 5
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5585
Mailing Address - Country:US
Mailing Address - Phone:801-808-5826
Mailing Address - Fax:
Practice Address - Street 1:2785 W 9000 S # 5
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5585
Practice Address - Country:US
Practice Address - Phone:801-808-5826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15853253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency