Organization
CIRQUE LODGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY FISHER (EXECUTIVE DIRECTOR)
(801) 222-9200
Entity
Organization
Contact information
Practice address
3114 E IDA'S ROAD, SUNDANCE, UT 84604
(801) 222-9200
(801) 222-0112
Mailing address
RR 3 BOX A10, SUNDANCE, UT 84604-8901
(801) 222-9200
(801) 222-0112
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
28275
UT
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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