=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891451712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLSVILLE RECOVERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2021
-----------------------------------------------------
Last Update Date | 09/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7877 S HWY 89-91
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-440-7050
-----------------------------------------------------
Fax | 385-240-6215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 440
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84339-0440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-440-7048
-----------------------------------------------------
Fax | 385-240-6215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MISS JESSICA DARLING
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 801-731-7757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------