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Organization

SUMMIT LODGE RECOVERY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOEL HANSON M.D. (ADMINISTRATOR)
(435) 427-8808
Entity
Organization

Contact information

Practice address
RR 1 BOX 73B, FAIRVIEW, UT 84629-9505
(435) 427-8808
Mailing address
RR 1 BOX 73B, FAIRVIEW, UT 84629-9505
(435) 427-8808

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
13564
UT

Other

Enumeration date
01/09/2008
Last updated
01/09/2008
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