| NPI | 1366650343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC PACKER Administrator 435-257-7441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: UT 2007ncf24) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2008-06-12 |