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General NPI Number Information
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NPI Number | 1467263004
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Entity Type | Organization
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Legal Business Name | EOS SERENITY LODGE
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 1445 E 5600 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4537
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Country | US
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Telephone | 801-513-7174
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 E 5600 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HILARY ROWBERRY
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Credential |
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Telephone | 801-513-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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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 |
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License Number State |
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