| NPI | 1124211123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL R LUKE Program Director 435-387-2223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: UT 12777) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |