Organization
HOMERUN CRISIS INTERVENTION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA MARIE GARNER RN (COO)
(435) 452-2662
Entity
Organization
Contact information
Practice address
205 QUARTER CIR, NIBLEY, UT 84321-6317
(855) 660-7200
Mailing address
PO BOX 437, HYRUM, UT 84319-0437
(435) 452-2662
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
163WC0400X
Case Management Registered Nurse
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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