Organization
PROJECT REALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL MILLARD DSW (EXECUTIVE DIRECTOR)
(801) 364-8080
Entity
Organization
Contact information
Practice address
150 E 700 S, SALT LAKE CITY, UT 84111-3806
(801) 364-8080
(801) 364-8098
Mailing address
150 E 700 S, SALT LAKE CITY, UT 84111-3806
(801) 364-8080
(801) 364-8098
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
370022-6004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134211626
—
UT
Enumeration date
04/27/2011
Last updated
04/27/2011
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