MEDICARE: JOURNEY AT WILLOWCREEK

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

General Provider Information

NPI Number	:	1861524464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY AT WILLOWCREEK

Provider Business Mailing Address
First Line	:	8072 HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5037
Country	:	US
Telephone Number	:	801-967-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	8072 HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5037
Country	:	US
Telephone Number	:	801-967-7664
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	LISA LANNON
Credential	:
Telephone Number	:	801-967-7664

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/14/2008

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