MEDICARE: BALANCE HOUSE

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	324500000X	Substance Abuse Rehabilitation Facility	18948	UT

General Provider Information

NPI Number	:	1740547298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE HOUSE

Provider Business Mailing Address
First Line	:	3464 ENCHANTED HILLS DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5407
Country	:	US
Telephone Number	:	801-943-0399
Fax Number	:	801-943-0365

Provider Business Practice Location Address
First Line	:	3464 ENCHANTED HILLS DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5407
Country	:	US
Telephone Number	:	801-943-0399
Fax Number	:	801-943-0365

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MISS KELLY ROBINSON-BILLS
Credential	:
Telephone Number	:	801-834-9751

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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Directions to “BALANCE HOUSE ” Practice Location

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