Provider Demographics
NPI:1972928760
Name:HEROS FOR INDEPENDENT LIVING
Entity type:Organization
Organization Name:HEROS FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-390-1441
Mailing Address - Street 1:655 MEDICAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5168
Mailing Address - Country:US
Mailing Address - Phone:801-390-1441
Mailing Address - Fax:
Practice Address - Street 1:655 MEDICAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5168
Practice Address - Country:US
Practice Address - Phone:801-390-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization