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General NPI Number Information
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NPI Number | 1750797619
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Entity Type | Organization
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Legal Business Name | OLYMPUS DRUG AND ALCHOL RECOVERY
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 425 MOULTON LN
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City | HEBER CITY
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State | UT
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Zip | 84032-3843
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Country | US
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Telephone | 801-608-4557
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Fax |
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Provider Business Mailing Address
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Address Line | 6271 S CANYON COVE DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6337
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Country | US
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Telephone | 801-608-4557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DUANE MICHAEL CONNER
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Credential |
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Telephone | 801-608-4557
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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 | 8266
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License Number State | UT
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