# WINDGATE WILDERNESS THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WinGate Wilderness Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275787251
- **Authorized official:** TIM DUPELL (MAJORITY PARTNER)
- **Authorized official phone:** (503) 585-1862

## Contact information

- **Practice address:** 1739 S HIGHWAY 89A, BUILDING A, KANAB, UT 84741-3957
- **Practice address phone:** (435) 817-1574
- **Practice address fax:** (435) 304-3199
- **Mailing address:** PO BOX 347, KANAB, UT 84741-0347
- **Mailing address phone:** (435) 817-1574
- **Mailing address fax:** (435) 304-3199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 14113 | UT | Yes |

## Other

- **Enumeration date:** 11/04/2008
- **Last updated:** 11/04/2008