Organization
AVALON HILLS ADULT HEALTH CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENITA J QUAKENBUSH (OWNER)
(435) 938-6060
Entity
Organization
Contact information
Practice address
550 W MOUNT PISGAH RD, PARADISE, UT 84328
(435) 938-6060
(435) 755-0439
Mailing address
PO BOX 3412, LOGAN, UT 84323-3412
(435) 938-6060
(435) 755-0439
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
11234
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82090000001001
BLUE CROSS BLUE SHIELD
UT
Enumeration date
09/06/2006
Last updated
05/20/2022
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