| NPI | 1063231611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH GOLESH Billing Manager 801-304-3489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2024-10-09 |