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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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