| NPI | 1457638587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS GARY MILNE Principal Of Board 435-669-4884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: UT 17338) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |