| NPI | 1508643222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUANE S. K. CLARK Owner 801-427-9169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-09-14 |