Organization
UTAH ADDICTION CENTERS
Active
Organization
UTAH ADDICTION CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY QUENTIN BOBERG LCSW (OWNER)
(801) 634-8938
Entity
Organization
Contact information
Practice address
2590 E PRAIRIE VIEW DR, EAGLE MOUNTAIN, UT 84005-6096
(801) 766-2233
Mailing address
2590 E PRAIRIE VIEW DR, EAGLE MOUNTAIN, UT 84005-6096
(801) 766-2233
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
13999
UT
324500000X
Substance Abuse Rehabilitation Facility
21344
UT
Other
Enumeration date
05/02/2016
Last updated
05/02/2016
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