| NPI | 1962947101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRYLYNN BACA-PELPHREY Cco, Exec Dir Payor Relations 801-658-9646 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0800X Clinic/Center, Recovery Care |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: UT 37088) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 37087) | |
| Enumeration Date | 2016-12-26 |
| Last Update Date | 2023-11-27 |