| NPI | 1164766077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET JACKMAN Owner 435-734-9511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |