Organization
EVA CARLSTON ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI RAGSDALE (EXECUTIVE DIRECTOR)
(801) 699-6563
Entity
Organization
Contact information
Practice address
4943 WASATCH BLVD, SALT LAKE CITY, UT 84124-4798
(801) 449-0089
(801) 204-9510
Mailing address
4943 WASATCH BLVD, SALT LAKE CITY, UT 84124-4798
(801) 449-0089
(801) 204-9510
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/11/2011
Last updated
09/11/2011
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