Organization
THERAPEUTIC WELLNESS CENTER
Active
Other names
Paragon Healthcare of Utah, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN FIELDING (EXECUTIVE DIRECTOR)
(801) 479-9644
Entity
Organization
Contact information
Practice address
5974 FASHION POINT DR, SUITE 100, SOUTH OGDEN, UT 84403-4699
(801) 479-9644
(801) 479-9639
Mailing address
5974 FASHION POINT DR, SUITE 100, SOUTH OGDEN, UT 84403-4699
(801) 479-9644
(801) 479-9639
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
7487072-0161
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U000072054
MEDICARE PTAN
UT
Enumeration date
10/14/2009
Last updated
05/31/2012
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