Healthcare Provider Details

I. General information

NPI: 1124474937
Provider Name (Legal Business Name): CPF RECOVERY WAYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4852 COMMERCE DRIVE
MURRAY UT
84107
US

IV. Provider business mailing address

4852 COMMERCE DRIVE
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-326-5180
  • Fax:
Mailing address:
  • Phone: 801-326-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number14434
License Number StateUT

VIII. Authorized Official

Name: DR. MARYANN ROSENTHAL
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D
Phone: 801-232-2124