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General NPI Number Information
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NPI Number | 1295107241
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Entity Type | Organization
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Legal Business Name | THE PHOENIX RECOVERY CENTER - FEMALE HOUSE
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 9538 S MORYWOOD LN
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-2349
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Country | US
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Telephone | 801-571-6798
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Fax | 801-619-2016
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Provider Business Mailing Address
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Address Line | 11762 S STATE ST SUITE 360
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City | DRAPER
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State | UT
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Zip | 84020-7155
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Country | US
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Telephone | 801-571-6798
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Fax | 801-619-2016
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | MR. BRADLEY RANDALL CHRISTENSEN
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Credential |
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Telephone | 435-773-5857
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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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