| NPI | 1104461060 |
|---|---|
| Doing Business As | INTERMOUNTAIN DAYSPRING - LOGAN |
| Entity Type | Organization |
| Authorized Contact | MARK BRIESACHER SVP Chief Phy Executive 801-442-3495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2020-11-24 |