Healthcare Provider Details

I. General information

NPI: 1194260810
Provider Name (Legal Business Name): BRC OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 S 900 E
SALT LAKE CITY UT
84117-5703
US

IV. Provider business mailing address

1265 E FORT UNION BLVD STE 140
MIDVALE UT
84047-1808
US

V. Phone/Fax

Practice location:
  • Phone: 801-869-1095
  • Fax: 801-869-1096
Mailing address:
  • Phone: 801-849-0453
  • Fax: 801-838-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number36133
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN SAUL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-849-0453