Extended Family, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

12040 Issued in UT

Legal business name

EXTENDED FAMILY, INC.

Practice address

704 N State Road 51
Spanish Fork, UT 84660-1385

Phone

(801) 794-0318

Fax

(801) 794-9514

NPI assigned

Mar 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul Wiederhold, PH.D.

Title

Executive Director

Phone

(801) 794-0318

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Extended Family2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Extended Family

  • Foster Care Agency
  • Spanish Fork, UT
  • NPI 1285065607
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215068267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 N STATE ROAD 51",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846601385",
            "telephone_number": "801-794-0318",
            "fax_number": "801-794-9514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 N STATE ROAD 51",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846601385",
            "telephone_number": "801-794-0318",
            "fax_number": "801-794-9514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED FAMILY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIEDERHOLD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-794-0318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "UT",
            "license": "12040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "788007788033",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Express Med Family Care LLC
• Expressmed Urgent Care Centers LLC
• Extended Family
• Extended Family Boys, Inc.
• Extended Family Girls, Inc.
• Eye Pros Spanish Fork LLC
• Eyemart Express LLC
• Michael P Eyre
• Family First Care
• Family First Medical PC

• Emotionally Disturbed Childrens' Residential Treatment Facility in Spanish Fork, UT
• Providers in Spanish Fork, UT by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.