Organization
SECOND CHANCES IN SOUTHERN UTAH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM MICHAEL AHQUIN (EXECUTIVE DIRECTOR/OWNER)
(435) 669-6669
Entity
Organization
Contact information
Practice address
591 NORTH STATE, LAVERKIN, UT 84745-8040
(435) 669-6669
(435) 571-0374
Mailing address
PO BOX 354, LAVERKIN, UT 84745-8040
(435) 669-6669
(435) 571-0374
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
8035
UT
323P00000X
Psychiatric Residential Treatment Facility
8035
UT
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/17/2014
Last updated
08/19/2020
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