Provider Demographics
NPI:1386063352
Name:ENTHEOS ACADEMY
Entity type:Organization
Organization Name:ENTHEOS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:EDVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-417-5444
Mailing Address - Street 1:4710 W 6200 S
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6702
Mailing Address - Country:US
Mailing Address - Phone:801-417-5444
Mailing Address - Fax:
Practice Address - Street 1:4710 W 6200 S
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-6702
Practice Address - Country:US
Practice Address - Phone:801-417-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)