| NPI | 1891032553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANN MAKIN President / General Manager 801-427-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: UT 20073) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 20074) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |