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General NPI Number Information
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NPI Number | 1952778649
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PEAK RECOVERY
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 14048 HIGHWAY 89
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City | SPANISH FORK CANYON
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State | UT
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Zip | 84660
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Country | US
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Telephone | 801-873-3199
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Fax | 801-873-3507
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Provider Business Mailing Address
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Address Line | PO BOX 361
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City | SPANISH FORK
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State | UT
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Zip | 84660-0361
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Country | US
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Telephone | 801-873-3199
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Fax | 801-873-3507
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DAVID CHANDLER
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Credential |
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Telephone | 801-824-4002
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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 | 12196
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License Number State | UT
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