Provider Demographics
NPI:1063281871
Name:TELOS U LLC
Entity type:Organization
Organization Name:TELOS U LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-426-8800
Mailing Address - Street 1:600 S GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-5803
Mailing Address - Country:US
Mailing Address - Phone:801-380-8830
Mailing Address - Fax:801-380-8830
Practice Address - Street 1:600 S GENEVA RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84059-5803
Practice Address - Country:US
Practice Address - Phone:801-380-8830
Practice Address - Fax:801-380-8830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELOS U LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children