| NPI | 1174193189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLDEN GLENN Owner 435-774-6533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-01-21 |