| NPI | 1154733319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN VIRGIN CEO 435-705-0142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 339436-3902) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2014-05-22 |