NPI 1811447725

Loose Cannon Social Work, LLC.

Organisation Exclusive Provider Organization Saint George, UT

Practice location

Address: 2298 E 200 S, Saint George, UT 84790-1603
Phone: (801) 652-4437

Authorised official

Name: Bruce Craig Solomon
Title: Manager
Phone: (801) 652-4437

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 8202232-3501 (UT)

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Registry record

NPI: 1811447725
Entity type: Organization
NPI issued: 4 Oct 2016
Record last updated: 4 Oct 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.