| NPI | 1871829283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE A. PETTIT Owner/Partner 801-984-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 15893) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2019-04-16 |