| NPI | 1144872516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE BUCK Credentialing Specialist 801-336-1839 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-15 |