| NPI | 1497204903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CL CANFIELD Owner 801-877-0705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| 207Q00000X Family Medicine | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2018-08-27 |