| NPI | 1164542379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH E EKONG Executive Director 801-360-6357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: UT 2004-20754) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |