| NPI | 1982945945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH ELAINE STICKLER Owner 801-628-0587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: UT 151362715) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2013-03-14 |