Organization
METAMORPHOSIS SALT LAKE CITY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY COSTLEY (CHIEF OPERATING OFFICE)
(801) 261-5790
Entity
Organization
Contact information
Practice address
339 E 3900 S, SUITE 101, SALT LAKE CITY, UT 84107-1677
(801) 261-5790
Mailing address
339 E 3900 S, SUITE 101, SALT LAKE CITY, UT 84107-1677
(801) 261-5790
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
5863251-8913
UT
Other
Enumeration date
11/19/2008
Last updated
11/19/2008
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