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General NPI Number Information
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NPI Number | 1376900209
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Entity Type | Organization
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Legal Business Name | ENVISION RECOVERY SERVICES INC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 5897 W ROUND ROCK DR
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City | HERRIMAN
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State | UT
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Zip | 84096-8202
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Country | US
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Telephone | 801-755-6112
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Fax |
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Provider Business Mailing Address
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Address Line | 5897 W ROUND ROCK DR
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City | HERRIMAN
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State | UT
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Zip | 84096-8202
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Country | US
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Telephone | 801-755-6112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOLYNN L OLIVER
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Credential |
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Telephone | 801-755-6112
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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 | 16694
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 11826
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License Number State | UT
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