| NPI | 1215642244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANA BAUER Insurance Manager 435-592-1718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-01-13 |