| NPI | 1780782508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANKS BOURGEOUS Co Founder 801-369-4466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: UT 11932) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-07-21 |