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General NPI Number Information
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NPI Number | 1033450275
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Entity Type | Organization
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Legal Business Name | ALPINE RECOVERY LODGE LLC
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1018 E OAKHILL DR
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City | ALPINE
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State | UT
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Zip | 84004-1733
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Country | US
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Telephone | 626-797-9977
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Fax | 626-844-2977
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Provider Business Mailing Address
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Address Line | 1018 E OAKHILL DR
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City | ALPINE
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State | UT
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Zip | 84004-1733
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Country | US
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Telephone | 626-797-9977
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Fax | 626-844-2977
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Authorized Official
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Title or Position | CEO
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Name | AMY ROTHERMEL
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Credential |
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Telephone | 626-797-9977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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