| NPI | 1962918631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULETTE JENSEN Contract Specialist 801-842-8365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2017-12-18 |