Organization
RED CIRCLE LODGE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANE SHEPHERD M.ED., LCMHC (CLINICAL DIRECTOR)
(435) 229-9437
Entity
Organization
Contact information
Practice address
930 N MEMORIAL ST, HILDALE, UT 84784
(435) 874-1467
Mailing address
930 N MEMORIAL ST #1670, HILDALE, UT 84784
(435) 874-1467
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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