Organization
CIRQUE LODGE INC.
Active
Organization
CIRQUE LODGE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY FISHER (DIRECTOR OF OPERATIONS)
(801) 222-9200
Entity
Organization
Contact information
Practice address
777 N PALISADES DR, OREM, UT 84097-4341
(801) 222-9200
(801) 222-0112
Mailing address
777 N PALISADES DR, OREM, UT 84097-4341
(801) 222-9200
(801) 222-0112
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
12370
UT
Other
Enumeration date
05/31/2007
Last updated
11/26/2016
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