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Organization
IMPERIAL HEALING ESTATE
Active
Organization
IMPERIAL HEALING ESTATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORNA BURR (OWNER)
(801) 598-7765
Entity
Organization
Contact information
Practice address
4194 IMPERIAL WAY, PROVO, UT 84604-5328
(385) 312-0352
Mailing address
1561 W ASPEN TRAIL DR, BLUFFDALE, UT 84065-5183
(385) 312-0352
(801) 210-7609
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
NULL
Other
Enumeration date
04/13/2018
Last updated
09/30/2019
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