Organization
MYSTIC MOTION INC
Active
Organization
MYSTIC MOTION INC
Active
Other names
Lighthouse Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRET RICHARD HINER LSAC,BRI-1 (PRESIDENT)
(801) 631-7122
Entity
Organization
Contact information
Practice address
7602 SOUTH MAIN STREET, MIDVALE, UT 84047
(801) 631-7122
(877) 840-9122
Mailing address
7602 SOUTH MAIN STREET, MIDVALE, UT 84047
(801) 631-7122
(877) 840-9122
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
15350
UT
Other
Enumeration date
06/11/2009
Last updated
06/11/2009
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