| NPI | 1023306297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY W DUSTIN Case Manager 801-582-1565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 284300000X Special Hospital (Licence: UT 184759-3102) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |