| NPI | 1922139245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL SANDERSON Clinical Director 435-878-2868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: UT 12200) |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: UT 12200) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |