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General NPI Number Information
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NPI Number | 1174021281
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Entity Type | Organization
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Legal Business Name | INSIGHT RECOVERY CEDAR CITY LLC
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 535 S MAIN ST STE 2
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City | CEDAR CITY
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State | UT
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Zip | 84720-3576
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Country | US
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Telephone | 801-718-3935
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Fax |
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Provider Business Mailing Address
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Address Line | 260 W SAINT GEORGE BLVD
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City | SAINT GEORGE
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State | UT
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Zip | 84770-3792
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Country | US
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Telephone | 801-718-3935
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Fax |
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | MR. JOSH L CAMPBELL
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Credential |
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Telephone | 801-718-3935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 53345
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 53345
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License Number State | UT
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