Organization
BLUE HILLS RESIDENTIAL TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN EDWARD COLBURN CMHCI (INTERN)
(435) 445-5200
Entity
Organization
Contact information
Practice address
2860 EAST 19500 NORTH, MORONI, UT 84646-0461
(435) 436-9029
(435) 445-5201
Mailing address
PO BOX 461, 2860 EAST 19500 NORTH, MORONI, UT 84646-0461
(435) 445-5200
(435) 445-5201
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235458555
—
UT
Enumeration date
07/16/2015
Last updated
07/16/2015
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