# IMPERIAL HEALING ESTATE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033606298
- **Authorized official:** LORNA BURR (OWNER)
- **Authorized official phone:** (801) 598-7765

## Contact information

- **Practice address:** 4194 IMPERIAL WAY, PROVO, UT 84604-5328
- **Practice address phone:** (385) 312-0352
- **Mailing address:** 1561 W ASPEN TRAIL DR, BLUFFDALE, UT 84065-5183
- **Mailing address phone:** (385) 312-0352
- **Mailing address fax:** (801) 210-7609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 3245S0500X | Children's Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 04/13/2018
- **Last updated:** 09/30/2019