| NPI | 1053638031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUG "TUG" B. WAGSTAFF Owner 801-376-4787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: UT 321749-6004) |
| Additional Taxonomies | 273R00000X Psychiatric Unit (Licence: UT 321749-6004) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2012-12-12 |