Organization
BLUE SAGE YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY C. HUSBANDS MSW (PROGRAM DIRECTOR)
(435) 835-4053
Entity
Organization
Contact information
Practice address
580 WEST 1500 SOUTH, MANTI, UT 84648
(435) 835-4053
Mailing address
PO BOX 6, MANTI, UT 84642-0006
(435) 835-4053
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
12439
UT
Other
Enumeration date
07/20/2007
Last updated
07/20/2007
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