Healthcare Provider Details

I. General information

NPI: 1750522405
Provider Name (Legal Business Name): EAGLE QUEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S MAIN ST
NEPHI UT
84648-1711
US

IV. Provider business mailing address

4063 ROSS DR
OGDEN UT
84403-3227
US

V. Phone/Fax

Practice location:
  • Phone: 435-623-1822
  • Fax: 435-623-1826
Mailing address:
  • Phone: 801-698-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number14872
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID S. ARSLANIAN
Title or Position: MANAGER/MEMBER
Credential:
Phone: 801-698-7095