| NPI | 1629339437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY K SODERQUIST Owner And Clinical Director 435-691-0856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH-3895) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-3895) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-11-21 |