| NPI | 1437544145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN J. LONG CEO 801-709-9419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 11599) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: 11599) |
| 1041C0700X Social Worker Clinical (Licence: UT 11599) | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: UT 11599) | |
| 283X00000X Rehabilitation Hospital (Licence: UT 11599) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2015-03-31 |