| NPI | 1518324383 |
|---|---|
| Other Name | RENAISSANCE RANCH OUTPATIENT - OREM MEN |
| Entity Type | Organization |
| Authorized Contact | CHERYL WACK Billing Manager 801-381-2928 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 4625) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-01-25 |