| NPI | 1285766238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA CASTLETON Executive Director 801-802-8608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: UT 12366) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 12366) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-08-22 |