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General NPI Number Information
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NPI Number | 1134929540
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Entity Type | Organization
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Legal Business Name | AVANT LUXURY MEDICAL DETOX
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 39 PROFESSIONAL WAY STE 1
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City | PAYSON
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State | UT
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Zip | 84651-1676
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Country | US
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Telephone | 801-473-4348
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Fax |
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Provider Business Mailing Address
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Address Line | 2967 INDIAN HILLS DR
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City | PROVO
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State | UT
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Zip | 84604-4324
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Country | US
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Telephone | 801-473-4348
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | ROBIN KNIGHT
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Credential |
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Telephone | 801-473-4348
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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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