MEDICARE: BUILDING BEGINNINGS RECOVERY

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
1	1041C0700X	Clinical Social Worker	8653220-3501	UT
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1700379369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BEGINNINGS RECOVERY

Provider Business Mailing Address
First Line	:	286 S 600 E STE A
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-4780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 S 600 E STE A
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-4780
Country	:	US
Telephone Number	:	208-240-7178
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MADALYN KENER
Credential	:
Telephone Number	:	208-240-7178

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	03/08/2019

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Directions to “BUILDING BEGINNINGS RECOVERY ” Practice Location

Language	Start Address	Practice Location

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