| NPI | 1548367881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI STONE Credentialing 801-355-2846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 11864) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-09-30 |