| NPI | 1376900209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLYNN L OLIVER Owner 801-755-6112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 11826) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 16694) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-01-22 |