| NPI | 1780900464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK ESPLIN Cpa 435-635-2390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2010-04-20 |