Provider Demographics
NPI:1679690804
Name:STEPPING STONESCHILD PLACEMENT AGENCY
Entity type:Organization
Organization Name:STEPPING STONESCHILD PLACEMENT AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-493-2100
Mailing Address - Street 1:180 E 2100 S
Mailing Address - Street 2:201B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2328
Mailing Address - Country:US
Mailing Address - Phone:801-493-2100
Mailing Address - Fax:
Practice Address - Street 1:180 E 2100 S
Practice Address - Street 2:201B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2328
Practice Address - Country:US
Practice Address - Phone:801-493-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========Medicaid