| NPI | 1336523695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN EDWARD COLBURN Inte RN 435-445-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-07-16 |