MEDICARE: TOOELE BEHAVIORAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881074342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOOELE BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	7832 S SERENERA WAY
Second Line	:	#310
City	:	WEST JORDAN
State	:	UT
Zip	:	84081-5775
Country	:	US
Telephone Number	:	801-918-5604
Fax Number	:

Provider Business Practice Location Address
First Line	:	7832 S SERENERA WAY
Second Line	:	#310
City	:	WEST JORDAN
State	:	UT
Zip	:	84081-5775
Country	:	US
Telephone Number	:	801-918-5604
Fax Number	:

Authorized Official
Title or Position	:	MANGER
Name	:	TOSHIA M DOWNS
Credential	:
Telephone Number	:	801-918-5604

Provider Enumeration Date	:	05/31/2015
Last Update Date	:	05/31/2015

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