Provider Demographics
NPI:1871349266
Name:MENDING MINDS VILLAGE
Entity type:Organization
Organization Name:MENDING MINDS VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KADEN
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:MATTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-259-3312
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-0310
Mailing Address - Country:US
Mailing Address - Phone:801-259-3312
Mailing Address - Fax:
Practice Address - Street 1:639 SWENSON AVE APT 1
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2560
Practice Address - Country:US
Practice Address - Phone:801-259-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle