| NPI | 1164048492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANIE WILLSON CFO 435-637-7200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 3336C0002X Pharmacy Clinic Pharmacy | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |