| NPI | 1790386837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LYNN BOBERG Executive D Irector 801-661-7007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2020-11-04 |