Healthcare Provider Details

I. General information

NPI: 1356758684
Provider Name (Legal Business Name): CPF RECOVERY WAYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4883 S BOX ELDER ST
MURRAY UT
84107-4730
US

IV. Provider business mailing address

4848 S COMMERCE DR
MURRAY UT
84107-4761
US

V. Phone/Fax

Practice location:
  • Phone: 801-293-6100
  • Fax: 801-281-1658
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 Number8662
License Number StateUT

VIII. Authorized Official

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