Healthcare Provider Details

I. General information

NPI: 1376900209
Provider Name (Legal Business Name): ENVISION RECOVERY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5897 W ROUND ROCK DR
HERRIMAN UT
84096-8202
US

IV. Provider business mailing address

5897 W ROUND ROCK DR
HERRIMAN UT
84096-8202
US

V. Phone/Fax

Practice location:
  • Phone: 801-755-6112
  • Fax:
Mailing address:
  • Phone: 801-755-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number11826
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number16694
License Number StateUT

VIII. Authorized Official

Name: MS. JOLYNN L OLIVER
Title or Position: OWNER
Credential:
Phone: 801-755-6112