Healthcare Provider Details

I. General information

NPI: 1881598415
Provider Name (Legal Business Name): BRC OUTPATIENT OREM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 S 740 E
OREM UT
84097-8081
US

IV. Provider business mailing address

1265 E FORT UNION BLVD STE 140
MIDVALE UT
84047-1904
US

V. Phone/Fax

Practice location:
  • Phone: 801-676-9322
  • Fax: 801-838-2100
Mailing address:
  • Phone: 801-676-9322
  • Fax: 801-838-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONATHAN SAUL
Title or Position: OWNER
Credential:
Phone: 801-676-9322