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Organization

SECOND NATURE WILDERNESS PROGRAM

Active
Other names
Second Nature Uintas
Organization subpart
No

Provider details

NPI number
Authorized official
ANGIE EVANS (BUSINESS OFFICE)
(801) 766-6604
Entity
Organization

Contact information

Practice address
382 WEST MAIN STREET, DUCHESNE, UT 84021-0318
(435) 738-2040
(435) 738-2046
Mailing address
382 WEST MAIN STREET, DUCHESNE, UT 84021-0318
(435) 738-2040
(435) 738-2046

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
18067
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11846
STATE LICENSE NUMBER
UT
Enumeration date
04/13/2007
Last updated
05/29/2012
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