Organization
DEER HOLLOW LAKESIDE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA R ROMANO (DIRECTOR OF FINANCIAL OPERATIONS)
(801) 759-1734
Entity
Organization
Contact information
Practice address
7904 S NORDIC TRAIL LN, BRIGHTON, UT 84121-1000
(801) 679-6669
(801) 203-9216
Mailing address
PO BOX 1078, DRAPER, UT 84020-1078
(801) 679-6669
(801) 203-9216
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
51884
UT
324500000X
Substance Abuse Rehabilitation Facility
53972
UT
324500000X
Substance Abuse Rehabilitation Facility
53992
UT
Other
Enumeration date
12/20/2017
Last updated
02/23/2018
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