Organization
TREVOR HANSEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL BAILEY (OWNER)
(435) 851-6821
Entity
Organization
Contact information
Practice address
21260 N. 1450 E., MORONI, UT 84646-0383
(435) 851-6821
Mailing address
21260 N. 1450 E., MORONI, UT 84646-0383
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000
—
UT
Enumeration date
02/06/2014
Last updated
02/06/2014
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