Provider Demographics
NPI:1992355630
Name:EAST WEST HEALTH PLEASANT GROVE LLC
Entity type:Organization
Organization Name:EAST WEST HEALTH PLEASANT GROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-640-1353
Mailing Address - Street 1:471 E 1000 S STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11020 N 5500 W # 101
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9643
Practice Address - Country:US
Practice Address - Phone:801-829-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-15
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty