| Bwl Enterprises Inc | |
|
925 Executive Park Dr Suite E Holladay UT 84117-3581 | |
| (801) 329-5872 | |
| Not Available |
| Full Name | Bwl Enterprises Inc |
|---|---|
| Speciality | Counselor |
| Location | 925 Executive Park Dr, Holladay, Utah |
| Authorized Official Name and Position | Brenda Ann Luker (PRESIDENT) |
| Authorized Official Contact | 8013295872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bwl Enterprises Inc 4623 S 600 E Salt Lake City UT 84107-3903 Ph: (801) 329-5872 | Bwl Enterprises Inc 925 Executive Park Dr Suite E Holladay UT 84117-3581 Ph: (801) 329-5872 |
| NPI Number | 1356588834 |
|---|---|
| Provider Enumeration Date | 01/21/2009 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Medicare PECOS PAC ID | 4486039112 |
|---|---|
| Medicare Enrollment ID | O20220916001583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356588834 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 3492833501 (Utah) | Primary |
| Provider Name | Brenda A Luker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770803421 PECOS PAC ID: 5799978383 Enrollment ID: I20101014001063 |
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