Organization
LEGACY OUTDOOR ADVENTURES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GILBERT HALLOWS (EXECUTIVE DIRECTOR)
(435) 836-2272
Entity
Organization
Contact information
Practice address
56 SOUTH MAIN STREET, LOA, UT 84747
(435) 836-2272
(435) 836-2274
Mailing address
PO BOX 400, LOA, UT 84747-0400
(435) 836-2272
(435) 836-2274
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/23/2011
Last updated
12/23/2011
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