Provider Demographics
NPI:1780343046
Name:LIFE LAUNCH CENTERS OF SOUTH SALT LAKE
Entity type:Organization
Organization Name:LIFE LAUNCH CENTERS OF SOUTH SALT LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-803-8240
Mailing Address - Street 1:230 N 1680 E STE J1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2588
Mailing Address - Country:US
Mailing Address - Phone:801-703-4830
Mailing Address - Fax:435-767-0278
Practice Address - Street 1:383 N STATE ST STE 201&202
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4771
Practice Address - Country:US
Practice Address - Phone:801-703-4830
Practice Address - Fax:435-767-0278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE LAUNCH CENTERS OF SOUTH SALT LAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty