| NPI | 1689150641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JOY BLUMELL Member/Manager 801-362-9953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 9838277-6004) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2018-07-12 |