Provider Demographics
NPI:1699420828
Name:LEARNING SOLUTIONS ROOSEVELT
Entity type:Organization
Organization Name:LEARNING SOLUTIONS ROOSEVELT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-621-1668
Mailing Address - Street 1:1360 W HIGHWAY 40 STE B
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4203
Mailing Address - Country:US
Mailing Address - Phone:435-789-5683
Mailing Address - Fax:
Practice Address - Street 1:1360 W HIGHWAY 40 STE B
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4203
Practice Address - Country:US
Practice Address - Phone:435-789-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health