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Organization

MOONRIDGE ACADEMY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. TAWNY J DAVIS L.C.S.W. (EXECUTIVE DIRECTOR)
(435) 890-9180
Entity
Organization

Contact information

Practice address
9450 W 2400 S, CEDAR CITY, UT 84720-6706
(435) 586-9585
(435) 586-4489
Mailing address
9450 W 2400 S, P.O. BOX 1067, CEDAR CITY, UT 84720-6706
(435) 586-9585
(435) 586-4489

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
12809
UT

Other

Enumeration date
05/11/2009
Last updated
05/11/2009
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