Organization
ELEMENTS WILDERNESS PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY COVINGTON (INSURANCE CONSULTANT)
(801) 466-3838
Entity
Organization
Contact information
Practice address
130 N MAIN STREET, HUNTINGTON, UT 84528
(801) 712-3372
Mailing address
5807 FONTAINE BLEU DR, SALT LAKE CITY, UT 84121-1819
(801) 712-3372
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
15403
UT
Other
Enumeration date
02/04/2010
Last updated
02/04/2010
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