| NPI | 1154714913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL GAEDE Director 801-410-1671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 268792-6004) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-17 |