Healthcare Provider Details

I. General information

NPI: 1295266559
Provider Name (Legal Business Name): ASPIRO ADVENTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W WAKARA AVE
MT PLEASANT UT
84647
US

IV. Provider business mailing address

63 E 11400 S #186
SANDY UT
84070
US

V. Phone/Fax

Practice location:
  • Phone: 801-349-2740
  • Fax:
Mailing address:
  • Phone: 801-349-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KATIE THOMA
Title or Position: CFO
Credential:
Phone: 801-703-4480