Organization
MIBOSPI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JARED BYRON DAVIS (OWNER)
(801) 675-1242
Entity
Organization
Contact information
Practice address
1490 E 5600 S, OGDEN, UT 84403-4525
(801) 675-1242
Mailing address
1490 E 5600 S, OGDEN, UT 84403-4525
(801) 675-1242
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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