| NPI | 1275894040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SLADE DEAN ZABRISKIE Owner 801-341-0411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 19203) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: UT 201201183) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-06-07 |