| NPI | 1396169728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET JACKMAN President 435-237-9154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: UT 21192) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |