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NPI Code Detail

MEDICARE: EVA CARLSTON ACADEMY

MEDICARE: EVA CARLSTON ACADEMY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility
2320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
33245S0500XChildren's Substance Abuse Rehabilitation Facility
4322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1427330968
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVA CARLSTON ACADEMY
Provider Business Mailing Address
First Line : 4943 WASATCH BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-4798
Country : US
Telephone Number : 801-449-0089
Fax Number : 801-204-9510
Provider Business Practice Location Address
First Line : 4943 WASATCH BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-4798
Country : US
Telephone Number : 801-449-0089
Fax Number : 801-204-9510
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KRISTI RAGSDALE
Credential :
Telephone Number : 801-699-6563
Provider Enumeration Date : 09/11/2011
Last Update Date : 09/11/2011

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Directions to “EVA CARLSTON ACADEMY ” Practice Location

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